[HN Gopher] HHS announces rule to protect consumers from surpris...
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HHS announces rule to protect consumers from surprise medical bills
Author : ThaDood
Score : 182 points
Date : 2021-07-02 17:19 UTC (5 hours ago)
(HTM) web link (www.hhs.gov)
(TXT) w3m dump (www.hhs.gov)
| Someone1234 wrote:
| Out-of-network was always just a sketchy way for insurance to
| avoid paying what they should have paid.
|
| Let's say you get a hypothetical procedure. Insurance has already
| agreed to pay in-network providers between $1-3K for this
| procedure. But you got this procedure out-of-network. Why is
| insurance's liability suddenly $0 instead of whatever the lowest
| in-network fee schedule would be ($1K in this example)?
|
| See I can understand insurance not wanting to foot substantially
| higher bills than in-network providers charge, but I cannot
| understand why it drops to $0 reimbursed when you leave network.
| It seems like an immoral "gotcha."
|
| But then again I'd like to see insurance discounts/agreements
| banned. Make everything and nothing in-network and also normalize
| the insured/uninsured prices. No more "$100 for a band-aid, -$99
| discount" shenanigans.
|
| Obviously single-payer would be better yet still, but if we must
| keep using this broken private employer-linked insurer system let
| us at least keep band-aid fixing it until we can get enough
| political support to scrap it.
| toast0 wrote:
| It kind of depends on the network. For a real owned and
| operated HMO where every provider in the network buildings and
| offices is an employee of the network (or under contract as a
| network provider), in-network only (for non-emergency services)
| makes a lot of sense to control costs, make staffing
| predictable, ensure consistency of care, etc. As an insured,
| you go to one building and get everything taken covered. If you
| want to go out of network for something, you need a good reason
| or be willing to pay for the whole thing.
|
| When it's a third party HMO network and you've got stuff like a
| medical office where only some doctors are in network and
| others aren't, so if your doctor is behind or out sick and
| you're offered to see another doctor in the interest of time
| and then you've seen an out of network doctor, that's a totally
| different deal. Then you've got things like in-office X-ray
| analyzed by an off-site radiologist whose identity and network
| status wasn't known before hand.
|
| I'd like to see non-emergency medicine take up the same kind of
| quoting requirements as auto repair. You can't always stop a
| procedure to update the quote, so provide several quotes for
| the likely outcomes.
| crazygringo wrote:
| I'm not defending it, but there is actually a logical
| justification here -- it's not just insurance companies being
| evil.
|
| When insurance companies sign up doctors to their network,
| doctors agree to lower fees (lower profit) but expect to make
| it up in volume, because the health plan will send them more
| patients.
|
| But that only works if patients are made to stay in-network,
| which produces the guaranteed volume. So health care plans
| won't pay if you go out of network. The economics would fall
| apart otherwise -- plans wouldn't be able to negotiate the
| lower prices because a doctor's office wouldn't see any uptick
| in volume.
|
| Now it depends on the plan, but there are often exceptions for
| when you're traveling and need emergency care -- they'll pay
| network rates toward that because it's not a visit that an in-
| network doctor would have lost.
|
| Also, plenty of "gold-plated" plans _will_ cover anything out-
| of-network as well -- because they 're expensive plans they're
| willing to pay doctors more, and so don't need to provide
| doctors with volume.
| throwawayboise wrote:
| The insurance companies own the networks. So it's a way for
| them to pay themselves rather than pay externally.
| deregulateMed wrote:
| Just a note, it's possible to lose money accepting some
| Medicaid insurances. Specifically if you need to hire a
| translator.
|
| $40/hr payout for physical therapy + translator contactor.
| bradstewart wrote:
| Totally agreed. My favorite is when you add this scenario to
| physically being somewhere without any in-network doctors.
|
| I cut my hand open climbing in northern New Mexico, bandaids
| and gauze weren't stopping the bleeding, so I went to the
| nearest town clinic/urgent care. Ultimately got 8 stitches.
|
| My insurance denied (almost) everything. They would later
| explain that I was supposed to drive myself several hours to
| Albuquerque to get my hand looked at instead.
|
| I say almost because the covered $70 for the lidocaine shot,
| but literally nothing else. Why they deemed the lidocaine
| necessary but not the stitches could not be explained. Clearly
| they had a way to pay the clinic, so wasn't that.
|
| Another whacky thing I discovered: the insurance company gets
| to decide how much, if any, of your uncovered, out-of-pocket
| bill counts towards your deductible. In this case they deemed
| $109 of $832 to be the right number, with no explanation as to
| how they arrived at that sum.
| jrs235 wrote:
| Should probably have gone to an ER. Emergencies are easier to
| argue and appeal. "Urgent" (yet less costly) and they assume
| you still could have waited... it wasn't an emergency yet. I
| hate our insurance/medical payment/determination system. It's
| a joke.
| ceejayoz wrote:
| They're looking at clamping down on that, too.
|
| https://arstechnica.com/science/2021/06/biggest-health-
| insur...
|
| > Doctors and hospitals are condemning plans by
| UnitedHealthcare--the country's largest health insurance
| company--to retroactively deny emergency medical care
| coverage to members if UHC decides the reason for the
| emergency medical care wasn't actually an emergency.
| sidewndr46 wrote:
| This was my experience as well. I went to the ER with
| tremendous chest pain, it turns out I have some issue
| with my ribcage. Not my heart. UHC decided I did not in
| fact need to see a cardiologist or an ECG since I wasn't
| having a heart attack and declined to pay for anything.
|
| Multiple attempts on my part to resolve this yielded
| nothing. I contacted the state of TX, who brought suit
| against both parties (insurance & service provider).
| Somehow, the day before the court appearance they all
| agreed to settle the claim at no cost to me.
| yellow_lead wrote:
| Good on you for being persistent.
| Workaccount2 wrote:
| Given the location and possible severity, the only viable
| way to an emergency room might have been a helicopter.
| Which insurance almost certainly would not cover.
|
| So the insurance is saying "If you paid $80,000 for a
| medevac, we would have covered your hospital bill".
| FireBeyond wrote:
| Hell, a few years ago UHC made the news because they were
| denying coverage for Flight EMS from serious car
| accidents due to "lack of pre-authorization".
| vinceguidry wrote:
| I went to an in-network urgent care for a particularly
| painful pinched nerve and got worthless drugs, and the
| uncovered part of the bill came out more than the covered
| part. Next time I'll just suffer at home and hope I don't
| die. It'll amount to the same result.
| vitaflo wrote:
| >Should probably have gone to an ER. Emergencies are easier
| to argue and appeal.
|
| ER visits for emergencies are also covered as in-network
| care under the ACA, even if you're half way across the
| country. I know cuz I was 1500 miles into a road trip when
| I went to the ER. My insurance covered it as in-network.
| JadeNB wrote:
| > Another whacky thing I discovered: the insurance company
| gets to decide how much, if any, of your uncovered, out-of-
| pocket bill counts towards your deductible. In this case they
| deemed $109 of $832 to be the right number, with no
| explanation as to how they arrived at that sum.
|
| Not that I think much of the likelihood of success, but
| aren't you, for any such decisions, entitled to (a) receive a
| justification on request, and (b) appeal that decision?
| handrous wrote:
| Screwing around with insurance process bullshit can easily
| exceed the value of whatever you're trying to
| regain/figure-out.
|
| Hours, literally, of on-hold time, likely more than once,
| and if you're trying to get them to pay for something they
| don't want to, you're likely going to need to get state
| regulators or lawyers involved, which means even more time
| (and money, in the latter case). Probably you'll end up
| having to do the same thing with one or more hospitals or
| healthcare providers, playing go-between with them and
| insurance, and usually those places subject you to the same
| malicious-incompetence as the insurer does.
| postoak wrote:
| Yes, but when the insurance company controls the appeals
| process, they will likely deny it.
| hef19898 wrote:
| The only similar thing I know in the EU is needing medical
| care abroad, meaning out side the country you are living in
| (more accurate, the country you are insured in). Then it can
| be scetchy, especially if certain procedures are not accepted
| in your country. But even then you only pay the difference,
| you have in some cases, pay upfront before you get reimbursed
| by your insurance. These differences tend to be rather small.
| Again from a German perspective, supplemental insurance for
| travel (global, including repatriation flights if necessary,
| and even helicopter evac) is very affordable. E.g. through
| the ADAC, the German automobile club.
|
| Ot is even possible for German citizens living abroad (I
| think outside the EU) to pay into a special insurance to
| maintain the German health insurance. Around 100 bucks or so,
| but I would have to read up on it again. Which is nice, e.g.
| because you travel full time or are an expat (the US comes to
| mind).
|
| Edit: That's one provider, the 1 year plan is 35 Euro, ythe 5
| year plan 59 per month.
|
| https://www.hansemerkur.de/langfristige-
| auslandskrankenversi...
|
| EDIT 2: Including the US and Canada prices increase by
| roughly 3 fold.
| LorenPechtel wrote:
| I believe they count what it would have been in-network.
|
| As for saying you should have driven hours with bleeding you
| couldn't stop--do you have any sort of appeal process? That
| certainly doesn't sound right.
| handrous wrote:
| It's pretty common for providers not to cover _anything_
| except ER visits, out of your home state. And that only
| because (I think) they 're required to. And I bet they
| interpret that as narrowly as possible ("heart attack, went
| to the ER, but then moved to a bed in a normal room? We'll
| cover the ER care but not the room or any care that took
| place there, have fun with bankruptcy").
|
| An urgent care might not count.
| jstrom wrote:
| You can theory-craft a non-malicious justification: Insurance
| trusts Dr. Hibbert will perform the procedure without
| complications and has negotiated a fixed price of $1K.
| Insurance doesn't trust Dr. Nick and believes any procedure he
| performs will result in a second claim later to set things
| right. Insurance strongly wants you to chose Dr. Hibbert and
| the only leverage they have is to refuse to pay for Dr. Nick
| should you go with him.
|
| Not sure how plausible that is though--I suppose they could
| data-mine frequency of follow-up treatment required per doctor
| --but I've never observed in network/out of network to
| correspond to a meaningful metric (our local dentist
| recommended by all the dental specialists around doesn't deal
| with any insurance companies, while the in-network dentist is
| pretty clearly padding their work)
| LorenPechtel wrote:
| Yeah. There is a legitimate quality reason but it doesn't
| appear to be how they actually operate. Reality is more like
| a local case that resulted in a lawsuit (never heard the
| outcome) against the insurance company for sending patients
| to your Dr. Nick.
| inetknght wrote:
| Why doesn't the insurance company trust Dr. Nick?
|
| If there's reason to not trust Dr. Nick, then surely the
| insurance company must disclose it. If there's reason to not
| trust Dr. Nick, then surely Dr. Nick would have trouble
| maintaining a medical license. If there's reason to not trust
| Dr. Nick then surely Dr. Nick's own malpractice insurance
| would become too onerous for him to keep.
|
| No, this smells exactly like what @Someone1234 stated:
|
| > Out-of-network was always just a sketchy way for insurance
| to avoid paying what they should have paid.
| jrs235 wrote:
| Sometimes the trust issue is more about fraudulent claims
| than one's ability to practice medicine...
| inetknght wrote:
| > _If there 's reason to not trust Dr. Nick, then surely
| the insurance company must disclose it._
|
| That should include "we think Dr. Nick makes fraudulent
| claims"
| jakelazaroff wrote:
| Then why is he still in business? If he's committing
| insurance fraud, then the insurance company should work
| with regulators to stop and potentially prosecute him.
| The onus to prevent fraud should not be on me as a
| patient.
| monknomo wrote:
| I mean, Dr. Hibbert might refuse to be in network for some
| insurance company because he doesn't like their rates. I
| think that's more common
| specialp wrote:
| The issue with single payer is all the special interests that
| already make our costs the highest in the world would lobby to
| make that single payer pay more. We have this already. Medicare
| cannot by law negotiate drug prices despite probably being the
| largest single payer.
|
| The out of network provider in an in network hospital is
| probably the most perverse thing to happen. One could be
| unconscious at a hospital and have out of network provider Dr
| Smith LLC stop in for a few minutes and send you her own bill.
| maerF0x0 wrote:
| This bill misses a big point. IMO should be there is only one
| price. Insured, in/out of network, regardless. A lot of times the
| reason an out of network rate is so high is because these
| providers are charging so much more for the same thing.
|
| Additionally it seems we have a supply vs demand issue if
| healthcare providers have such pricing power. Maybe it's time to
| open up the training supply and let folks with a 3.3GPA become
| doctors?
|
| EDIT: looks like maybe the supply issue is more about residency
| than med school https://www.fiercehealthcare.com/practices/more-
| medical-stud...
| mchusma wrote:
| I don't love this solution to the problem.
|
| This doesn't help anyone paying cash for services, and it really
| just invests more into the current broken system.
|
| I think the solution is that all healthcare providers must
| provide upfront pricing for you.
|
| Right now, almost all medical billing is surprise billing. It's
| basically the only sector where this is true.
| pavon wrote:
| Agreed. I think the biggest problem is that the providers
| themselves are as much in the dark as the customers when it
| comes to knowing what insurance will actually pay. So they
| submit some highball number and see what comes back. I think
| what is needed more than anything else is to require insurers
| to provide an API to providers that will give a legally binding
| coverage quote instantly, before services are provided, not
| months later.
|
| There will be some qualifiers to that, like the provider must
| indicate what conditions the patient is being treated for to
| qualify for the procedure, and if the patient doesn't actually
| have that condition, then whoever falsified the information (or
| was grossly negligent in diagnosing) is stuck with the bill.
|
| Once that is in place, then you can require the providers to
| give quotes beforehand.
| kevmo wrote:
| The entire insurance industry should just get axed.
|
| USA is dumping twice as much money in as Canada/Europe for worst
| outcomes.
|
| Warren Buffet has described our insurance system as the "tapeworm
| of the American economy".
| spaetzleesser wrote:
| Makes you wonder how many non rich people who could start
| businesses and stuff are working for corporations just fir the
| health insurance. I think it's many and it's a huge drain on
| innovation. On the other had it keeps the little guys dependent
| on corporations so I guess it's a welcome feature for the upper
| class.
| heavyset_go wrote:
| Rates of entrepreneurship are higher in Scandinavian
| countries[1].
|
| I believe that comes down to the fact that in those
| countries, you don't have to already be wealthy enough to
| afford the $36k in premiums alone each year in order to just
| insure a family with one kid on the individual insurance
| market. That $36k doesn't include the $18k+ yearly
| deductible, nor the co-pays or cost of care or medicine when
| actually utilizing the insurance.
|
| [1] https://www.oecd.org/sdd/business-
| stats/EAG-2018-Highlights....
| slownews45 wrote:
| Part of this is we also agree to spend high amounts of money
| for things like end of life car. Other countries simply do not
| spend $10M on you at end of life - period.
| kzrdude wrote:
| Is there statistics to support this? Northern europe also
| spends a lot of resources on end of life and other serious
| conditions.
| slownews45 wrote:
| My only experience is really with places like Costa Rica /
| some Caribbean locations. My impression was they spent a
| lot less on health care - and end of life care was much
| more modest. That said, overall health didn't seem too bad.
|
| One thing I liked a lot - for basic health care - you could
| really just walk in and get near immediate service for a
| modest fee (doctors did not live in oceanside mansions).
| Prescriptions were laughably easy to get as well -
| antibiotics etc that in the US meant going to doctor,
| getting scrip, calling it into pharmacy, going to pharmacy
| etc - all that appears just much less regulated in some of
| these places. Basic imaging services / dental services also
| inexpensive.
|
| They just didn't have the super advanced stuff you see in
| the US. So I just don't think you could spent $10M during
| last 12 months of life there, they don't have
| infrastructure / equipment to do that even if you wanted.
| So folks probably die earlier as a result?
| kzrdude wrote:
| You should compare outcomes and expenses in the US with
| really well developed health care systems like UK,
| Germany, Denmark or others.
|
| US still ranks as spending almost double (in total) per
| person than any of those countries. Does it have better
| outcomes? Better late stage life? Does it even have the
| same level of outcomes, with the higher price?
| manuel_w wrote:
| Well, they don't have to, because it simply doesn't cost $10M
| there. My understanding is that the United States medical
| system foremost goal is to generate profit (for
| shareholders?), and I think that artifically inflates the
| prices. Many people share the oppinion that there's no need
| for the medical system to make profit -- not incuring loss is
| enough for it being sustainable.
| throwawayboise wrote:
| Its not just profit. Yes doctors and health care
| organizations need to make a profit. But the prices are
| also inflated so that those who do pay (either out-of-
| pocket or via insurance) cover the costs for those who
| don't (those with no insurance and no assets).
| treyfitty wrote:
| Anecdotal: my dad had a heart attack and was in the hospital for
| 6 months due to complications. After a certain amount of time,
| the bills started to rack up and we were being charged for
| services that we thought would be covered under "health insurance
| coverage." Instead of being covered, the health insurance
| provided coverage for standard hospital care, but we were charged
| every time a non network doctor stepped into his room. Then, the
| non-covered machines that were used. Then, stupid things like
| "staying in an ICU longer than allowed by coverage."
|
| My father passed away before making it home, but when all was
| said and done, insurance was billed $10 million in total, of
| which the various doctors and hospitals billed the estate $2
| million. My dad didn't have an estate because he had no assets.
| But imagine your life + childrens' lives being ruined for having
| insurance yet filled with invisible asterisks.
|
| At the time, NJ laws were onerous in this regard and favored
| insurance companies so we had no recourse. The state had a
| process for dealing with issues like this, but it was more of a
| cursory "jobs done here boss" type process and didn't provide
| consumers with relief. Because of that, I moved my family out of
| NJ. When all contingency plans are filled with asterisks, do you
| really have insurance/protection?
| ohazi wrote:
| > having insurance yet filled with invisible asterisks.
|
| "Invisible asterisks" captures the reality perfectly. The
| asterisks are invisible and infinite. I think even Kafka would
| be horrified.
|
| We've turned medical billing into an impenetrable Byzantine
| hellscape, and I fear that the only way to fix it would be to
| nuke it from orbit and start over.
| cwkoss wrote:
| Medicare For All is the single most important policy in
| American politics right now, IMO, for this exact reason.
|
| People complain that all the people in private insurance will
| be put out of their jobs - I view that as a feature, not a
| bug.
| ryandrake wrote:
| Sorry for your loss. This is one of the things that tends to
| get overlooked when discussing how awful the US health care
| industry is. You always hear: "US health care is terrible
| unless you have insurance!" But, it's also terrible when you
| have insurance! There are all kinds of ways doctors, hospitals,
| and insurance companies conspire to drain your pockets or your
| loved ones' estate's pockets, and they're all likely documented
| somewhere in a 100 page policy. The system is irredeemably
| beyond repair.
| nrmitchi wrote:
| It more and more feels like the difference between not having
| insurance, and having insurance when something bad actually
| happens is "do I get a massive bill that I can't afford now,
| or do I get a massive bill that I can't afford later?".
|
| The only real benefit of having "insurance" in the US is
| having reasonable access to basic preventative care. Don't
| get me wrong, it is a _massive_ advantage to have default
| access to basic preventative care (without it being a cost-
| benefit tradeoff each time), but that is in no way
| /shape/form "insurance" in the typical meaning of the term.
| usefulcat wrote:
| > The only real benefit of having "insurance" in the US is
| having reasonable access to basic preventative care
|
| What insurance do you have where the cost of the annual
| premium is less than what the out of pocket costs would be
| for annual checkups for the covered individuals?
|
| I have the cheapest insurance I can get. Yes, it pays for
| basic preventative care (basically a checkup per person per
| year), and it also costs more than my mortgage.
| majormajor wrote:
| Most of the time the system works for people who have good
| coverage. The tragedy is that "having good coverage" is a
| hard-to-control combination of luck in employer and/or
| wealth.
|
| It's terrible that these things happen at all, and we
| CERTAINLY need to improve the US healthcare system, but
| exaggerations like "the only benefit of insurance in the US
| is access to preventative care" doesn't help. If people
| were regularly getting fucked like that the system wouldn't
| have the entrenched support it does from the "but I want to
| keep my insurance" camp, and so speaking in generalities
| like that just makes you appear uninformed to the millions
| who regularly see doctors, get treatment, have surgery,
| etc, without these problems.
|
| It also cheapens the inequality problem: the gap isn't just
| "has access to preventive care" vs "doesn't have that
| access." The gap is "has hundreds of thousands of dollars,
| or even millions, of bills turn into nothing" vs "bankrupt
| if they seek treatment for any serious problem."
| pavlov wrote:
| _> "If people were regularly getting fucked like that the
| system wouldn 't have the entrenched support it does from
| the "but I want to keep my insurance" camp"_
|
| I don't see how that follows.
|
| The "I've got mine" camp doesn't care that it happens to
| those other people, and also doesn't understand that it
| could happen to them in their old age (or simply after
| bad luck) because they've only made short visits into the
| system.
| nrmitchi wrote:
| > If people were regularly getting fucked like that
|
| I'm not sure what point you're trying to make, but it
| sounds like you're making the claim that people in the US
| _don 't regularly end up with massive surprise medical
| bills_? This entire conversation is about action the
| government is taking _because it happens so often_.
|
| > "has hundreds of thousands of dollars, or even
| millions, of bills turn into nothing"
|
| That's not really how that works. It's not like your
| insurance company is actually paying "millions of
| dollars", they're paying some level of reasonable
| negotiated rate. If they actually had to pay "millions of
| dollars", that's when they claim something is not covered
| and you get stuck with a bill anyways.
|
| Edit: First quote was just _wrong_ from a bad copy /paste
| ohazi wrote:
| > Most of the time the system works for people who have
| good coverage.
|
| I'm sorry, but I just can't see how this is true. Do you
| _only_ go to the doctor for a yearly checkup, or
| something?
|
| I've had "good" coverage (paid for by big employers with
| cushy all inclusive packages), and I've also had the
| cheapest option on CA's exchange, and the only difference
| was whether I had to pay the receptionist $25 or $150.
|
| The "we won't cover this" and the "surprise, this costs
| 50x what you were told!" billing nightmare comes six
| months later. This has happened with every insurer I've
| ever had.
| rootusrootus wrote:
| It really does vary by individual. My mom is going
| through cancer treatment right now. 35K/month in
| medication and she pays $250. I don't expect surprise
| bills later. She had surgery 8 years ago for the same
| cancer and that was also $250, for a week-long hospital
| stay.
|
| In my experience it does help to have an HMO. My mom uses
| Kaiser. So there's none of this in- vs out-of-network.
| One billing system, one insurance, etc. She has nothing
| but positive things to say about them. My dad had a
| similar experience towards the end of his life. He loved
| 'em. And nobody was left destitute as the result of his
| medical care.
| nrmitchi wrote:
| One of the problems with the how the US medical system
| works is that "35K/month in medication" is only
| "35k/month" because of some expectation that insurance is
| going to pay whatever the negotiated rate it (and I
| _seriously_ doubt that it 's 35k/month).
|
| Lets look at it this way: If that was the true price,
| what percentage of the US population do you think has the
| funds to actually pay $420k/year in for medication?
| rootusrootus wrote:
| In this case the insurance is paying $25K/month for the
| medication, so they definitely did negotiate it down
| somewhat.
|
| > what percentage of the US population do you think has
| the funds to actually pay $420k/year in for medication?
|
| Zero, plus or minus. That's why the manufacturers
| basically give it away to people who can't afford it.
| Because they can, and it helps them somewhat mitigate the
| bad PR.
| hef19898 wrote:
| That shouldn't be the exception, that should be the rule.
| NationalPark wrote:
| I've had "good" coverage for my 15 year career and it
| does not work most of the time, or even half of the time.
| I've paid bills out of pocket because I didn't have time
| to untangle payer/insurance situations. I was taken to
| the ER unconscious once after a freak accident and ended
| up paying thousands for the ambulance. I've had to do
| provider paperwork myself and submit it to insurers
| myself because they refused to help me help them get
| paid. The system is simply not functional for people who
| don't have huge amounts of free time, patience, and
| money.
| pkaye wrote:
| That is why I like the Kaiser HMO system. Most of the
| rates are pre-negotiated since the hospital and insurance
| are under the same company. Its typically $20/40 copay
| for a doctor visit. Even for me with my kidney failure
| and health issues, the OOP is minimal.
| ryandrake wrote:
| When you have insurance, a claim _should_ become purely a
| discussion between your insurance company and the health
| providers. It seems the current system needlessly inserts
| the patient into the middle, for the purpose of torturing
| him /her with paperwork, threats, bills, threats of bills,
| and the need to learn the intricacies of in-network,
| deductibles and co-pays, lifetime maximums, covered vs.
| uncovered procedures, etc. Instead of the insurance and
| health companies privately fighting it out between each
| other, they stick you in the middle, fighting through you
| as the proxy/punchingbag.
|
| Wouldn't it be better if you went to the hospital, gave
| them your insurance information, and that's the last you
| ever were involved with anything regarding payment? Isn't
| that one of the reasons we have insurance?
| dave_aiello wrote:
| My wife is a primary care doctor in the United States. Saying
| that disqualifies me in some people's minds from having an
| opinion about the quality and cost of health care in this
| country. But I am willing to give an opinion regardless.
|
| There are plenty of medical practices and institutions that
| function well and deliver good value to the patient. But
| there are many that do not.
|
| As someone who doesn't have friends inside the health care
| industry, it can be extremely difficult to figure out what to
| do in an emergency. Quite often your options are limited
| especially if you are caring for a loved one rather than
| yourself.
|
| The best advice I can give is to find good doctors before you
| need them, and when conversations come up about someone
| else's medical care, be willing to ask, who is your doctor
| and how good are they? Or, which hospital did you go to, and
| do you feel you had a good experience?
|
| Often there is little out-of-pocket difference between the
| cost of excellent medical care and lower quality care, if you
| have good insurance.
|
| If you don't have good insurance and you are looking at a
| potentially significant medical procedure, ask to speak to
| someone about financial assistance. Good practices and good
| hospital systems are not looking to bankrupt their patients.
| lmeyerov wrote:
| am happy to see HHS moving forward, long overdue!
|
| most US doctors are part of a bigger group in order to
| provide more comprehensive coverage (and due to systematic
| buyouts), which in turn have preferred insurance providers
| and additional out-of-network providers, and emergency
| services are generally for wherever an ambulance takes you.
| your physician may be great, but they are just a tiny cog
| in a broken machine
|
| one of the only outs, afaict, is something like working &
| living near a big & strong HMO like kaiser. but that comes
| at the cost of pretty firm boundaries on what services they
| allow: capped care
|
| (my SO is also a physician at one of the nation's best
| hospitals, and despite that, patients struggle w the
| broader system outside of her practical daily control)
| lotsofpulp wrote:
| >There are all kinds of ways doctors, hospitals, and
| insurance companies conspire to drain your pockets
|
| People also want cutting edge care from some of the smartest
| and most highly educated people in the world (which is in
| short supply) for cheap.
| heavyset_go wrote:
| When I lived in Manhattan and worked with some really
| wealthy clients, they'd fly to France, Israel and elsewhere
| for care when they could have easily gotten the best care
| the US has to offer right down the street.
| Arrath wrote:
| There is a pretty large continuum of potential value
| between the 'cheap' care that people want, and the ruinous
| bills that get charged.
| Goronmon wrote:
| _There is a pretty large continuum of potential value
| between the 'cheap' care that people want, and the
| ruinous bills that get charged._
|
| That can't be true, everyone knows that people are only
| greedy and stupid, and it's really the citizens' fault
| for the prices of the current healthcare setup. The
| industry itself is all made up of kind-hearted super
| heroes who would never think of manipulating prices to
| syphon more money from patients.
| lotsofpulp wrote:
| Ruinous bills are frequently used to cover the costs of
| routine procedures. It's another situation where 10% of
| the healthcare consumes 90% of the resources. It's the
| person who needs 6 months in the hospital, the 2 month
| premature baby in NICU, the hemophiliac that needs $1M
| medication that balloon all the costs.
|
| And no one can really afford that, but instead of
| spreading the costs around to all taxpayers, we were
| spreading it around by inflating everything else. ACA
| helps with this, but today's announcement about out of
| network care will help more too.
| mahathu wrote:
| Are American doctors really smarter than Dutch or Swedish
| doctors?
| [deleted]
| lotsofpulp wrote:
| The context is Americans getting healthcare, so Americans
| would be choosing from people in America.
|
| I would also point to the unnecessarily arduous and
| lengthy process of becoming a doctor in the US as one of
| the US system's problems.
|
| If I'm going to be asked to sacrifice all of my 20s and
| maybe early 30s and worked on 24 hour shifts during the
| prime of my life, I am also going to be making sure I get
| paid a ton for it. Otherwise, I would choose a different
| career.
|
| I know a lot of doctors that advise their kids to not
| pursue medicine even if they want to do it, simply
| because the cost benefit is not worth it anymore (if you
| have other options).
| kube-system wrote:
| They're probably comparable, but one advantage, no doubt
| due to our high costs, is that US hospitals tend to have
| a ton of resources and the latest equipment. This does
| make a difference if you have a condition that benefits
| from cutting edge treatments.
|
| I recently had a family member get surgery for a life
| threatening condition where a cutting edge treatment
| greatly reduces complications. The equipment only exists
| in a small number of hospitals on the planet and their
| normal hospital, which wasn't even a particularly fancy
| US hospital, had one. It's probably not an issue for
| small and rich countries though. Probably more-so for
| medium income countries.
| Goronmon wrote:
| _People also want cutting edge care from some of the
| smartest and most highly educated people in the world
| (which is in short supply) for cheap._
|
| Actually, people just want someone to help them with their
| health issues and not treat them like shit.
|
| Sure, I guess you could find people with the above
| attitude, but it's mostly a straw man you are using to
| deflect responsibility from the health industry.
| mikepurvis wrote:
| In 99% of cases, you don't need or want cutting edge
| care-- you need basic, efficient, timely care. The rest
| of the world manages to deliver that as a basic human
| right.
| brutus1213 wrote:
| Yes .. but. Canada is often pointed at by Americans as an
| example of a functioning healthcare system. I can tell
| you we have many problems, but they are different. It
| might mean long queues for basic
| diagnostics/assessments/procedures, facilities that look
| ugly, excessive waits in the ER, and still paying an arm
| and a leg for medication. I have heard of great
| experiences in Canada but also pretty terrible ones.
| dragonwriter wrote:
| > Canada is often pointed at by Americans as an example
| of a functioning healthcare system.
|
| To be fair, Americans have a _very low_ standard for
| "functioning healthcare system" due to the American
| healthcare system.
| wahern wrote:
| There are HMOs, like Kaiser, that solve most of these
| problems. Unless I'm traveling, I would never have to
| worry about such extraneous bills. However, for any
| particular serious condition a particular HMO might not
| have the top-rated team in the country. This unreasonable
| fear is used by non-HMO insurance networks to draw
| customers.
|
| Perhaps what we need is something like the WTO's most-
| favored-nation rule for domestic insurers, but imposed
| statutorily. If you're treating an out-of-network patient
| extemporaneously, you can only charge that person's
| insurer at the lowest rate you'd charge an in-network
| provider.
|
| This would remove the incentive for out-of-network
| providers to eagerly provide many services. That has its
| own downsides, of course, but it might help to resolve
| many of these billing nightmares.
|
| But, heck, maybe something like that already exists.
| Obamacare (aka ACA) comprehensively thought through many
| of these dilemmas. But enforcement has been gutted by the
| GOP.
| mokus wrote:
| Personally, I just want to know the cost of services before
| committing to pay. I have been unable to get that in many
| situations, even for non-emergency care.
| lotsofpulp wrote:
| I do too. A doctor should be able to give you the codes
| for whatever routine or preventative procedure you're
| interested in paying for, and you should be able to look
| up the price on your insurance company's website.
| nradov wrote:
| It's not that simple. Doctors themselves often don't even
| know which billing codes will be used; coding is done by
| other office staff. And insurers don't have a single set
| price list. The patient's out of pocket expense will
| depend on a medical necessity determination and whether
| they have reached their annual maximum.
| lotsofpulp wrote:
| That is why I specified for routine or preventative
| procedures, where everything is known beforehand.
|
| I also do not buy that doctors do not know which code
| will be used. I don't care if the doctor themself does
| not know, surely someone that works with them knows and
| can provide it.
|
| It should be dead simple to go to a doctor's website and
| find the codes for routine procedure that they will bill.
| If something in the visit happens outside of that, the
| doctor can feel free to say that is outside of the scope
| of the visit, just like a mechanic can tell me he will
| not fix the transmission if I am in for a brake job.
| rajup wrote:
| Wrong. YOU might want cutting edge care from the smartest
| and most highly educated people in the world (not sure
| where you get this from however, healthcare in most of the
| developed world is equally good). Most people want decent
| care that does not involve them worrying that the next
| healthcare bill will bankrupt them. I highly doubt
| ludicrous hospital bills are a necessity to getting
| "cutting edge care", if so something is definitely broken
| (and is).
| heavyset_go wrote:
| Where did you move to that has better protections for patients
| regarding health coverage?
| gnopgnip wrote:
| Was this before 2010?
| antattack wrote:
| We (society) cannot afford to pay for everyone's 10 million
| dollar hospital bills so how do we decide who gets their bills
| paid?
|
| EDIT: Some argue here that it'll average out, however at what
| cost to others? [1]Here's article about African Americans
| getting limbs amputated as their treatment for diabetes.
|
| [1]https://features.propublica.org/diabetes-
| amputations/black-a...
| majormajor wrote:
| Not everyone is going to have a 10 million dollar hospital
| bill. That's the entire point of insurance, and also the
| point of having a national plan: you generally aren't going
| to know if you're going to have a lifetime expense of 10K or
| 10M. So you need to aggregate that across the entire
| population.
| chris_wot wrote:
| Why? Works ok in Australia.
| jakelazaroff wrote:
| Most people don't have 10 million dollar hospital bills.
| That's how insurance works: everyone pays in case something
| happens to them, and the people who have expensive treatments
| are subsidized by those who don't.
|
| Insurance is more effective at dispersing that cost when the
| pool is larger, so the most effective scenario would be for
| _everyone_ to pay in via taxes and simply... be covered.
|
| Edit: I don't understand the point you're trying to make with
| your edit.
| shadowgovt wrote:
| > At what cost to others?
|
| Assuming nothing else changes, it'll about double the cost of
| what people pay now for private insurance (in terms of
| taxes).
|
| However, there's no reason to assume nothing else changes.
| The US spends an atrocious amount on the overhead of
| bookkeeping our "free-market" semi-adversarial healthcare
| system. Estimates over the past 22 years range from 13 to 25%
| of the cost is raw administration. Assume most of that cost
| goes away (let's say 90%, which seems fair) and you're left
| with Americans paying about $250-400 a month more on average
| in taxes for healthcare than what is paid now.
|
| Since it's taxes, the progressive tax rate would kick in and
| this would translate overall to most Americans paying almost
| nothing more, the middle class getting squeezed (this could
| be ameliorated with laws, but if nothing else changes the
| middle class gets squeezed), and the wealthy and super-
| wealthy shouldering the bulk of the cost.
| nrmitchi wrote:
| I think a piece that you're missing here is that health
| problems get drastically worse, and more expensive to fix,
| when they're not addressed.
|
| Problems are often not addressed in a reasonable time frame
| because many people don't have access to reasonable health
| care. Even they they _do_ , they may be hesitate to use it.
| Anecdotally, last time I went for a preventative check, I
| was given an FAQ sheet when I signed in reminding me that
| if I ask about anything specific, or diagnostic, that is
| _not_ preventative (as if I 'm supposed to understand the
| difference), then it would have to be billed separately and
| may-or-may-not be covered by my insurance. That was almost
| enough for me to _not ask my doctor questions while I was
| at the office_.
|
| I would imagine that more widely addressing issues early on
| before they become expensive would remove another large
| portion of overall US healthcare costs.
| 908B64B197 wrote:
| Rather, were services purchased really worth 10 million
| dollars?
|
| How much of that are salaries for underperforming, bloated
| structures in charge of "management" and billing?
| antattack wrote:
| Canadians spend 220k (in 2013) per person per lifetime.
| It's very unlikely you can shrink 10 million dollar bill to
| anywhere close to that.
|
| [1]https://www.theglobeandmail.com/life/health-and-
| fitness/heal...
| yladiz wrote:
| What makes Americans that much more expensive than
| Canadians?
| slownews45 wrote:
| It's mostly end of life care (relative to other
| countries).
|
| So during your life - broken bones etc - roughly equal.
|
| But if you are stuck in ICU for a year when 75+ - that's
| uniquely American and incredibly expensive.
|
| "Numerous articles on EOL costs show that a large
| proportion of Medicare expenditures occur during the last
| 6 months of life.1-9 This phenomenon has continued for
| many years as the number of Medicare decedents has
| increased with the aging American population. Medicare
| expenditures for EOL have increased dramatically from
| 1983 to 2016, primarily because of the increase in the
| number of decedents. Other articles compare EOL
| expenditures in the United States to other countries10,11
| or focus on Medicare expenditures for specific
| diseases.12-14 A recent development in the literature
| challenges the idea that EOL costs are responsible for a
| high percentage of health-care costs.15
|
| - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6610551/
| asdfasgasdgasdg wrote:
| I am aware that EOL care is a large part of the costs of
| our system. However, one thing I have not heard is any
| definitive evidence that that is materially different in
| the US vs. e.g. Canada or the UK.
|
| This study suggests that your interpretation is not
| correct: https://www.healthaffairs.org/doi/10.1377/hlthaf
| f.2017.0174 Mean end of life spending is only marginally
| higher in the U.S. than in other countries.
| slownews45 wrote:
| I thought something like 25% of medicare spending was in
| last year of life spending.
|
| I've also heard that something like 5% of folks generate
| 50% of costs.
|
| So the argument has been that because in the US total
| expenditure can go so high (ie, we will easily spend $10M
| on one person where other countries won't) that you end
| up with a serious spike as a result of last year of life
| and extraordinary effort costs.
|
| Other countries have less variance (including income
| inequality)
| antattack wrote:
| From the study (~1980 data) [1]: Cost of care in the last
| year of life in USA varied from study to study, between
| US$40,000 to US$95,776.
|
| Extrapolated cost for Canada: 6,758.2
|
| [1]https://www.longwoods.com/content/20878/healthcare-
| quarterly...
| rblatz wrote:
| Other countries seem to manage it.
| plank_time wrote:
| Do the children have to pay off the bills of the parent? That
| doesn't seem reasonable to me. It sounds like the best thing to
| do before getting too old is to transfer all your assets out so
| that if you die you won't have it robbed by hospitals, etc.
| irrational wrote:
| No, they do not. However, the companies in question still
| might try to get the children to pay up in the hopes the
| children are ignorant that they are not responsible for their
| parent's debts.
| bpodgursky wrote:
| No, children aren't responsible for bills. It can only come
| from your estate.
|
| Transferring assets isn't crazy but you do need to be careful
| if you want to do it in a non-taxable manner (you can't just
| give your kid $500k cash without them counting it as income).
| memling wrote:
| > No, children aren't responsible for bills. It can only
| come from your estate.
|
| I think it's worth noting that while this may be true if
| you're dead, it's not the case when you're still alive.[1]
|
| Filial responsibility laws mean that adult children can be
| legally required to pay their impoverished parents' medical
| bills. The above cites a case where a man was required by
| the courts to pay $93,000 for his mother's
| rehabilitation.[2] From what I've read, Pennsylvania may be
| particularly onerous compared to other states, but it's not
| a slam dunk kids won't be on the hook.
|
| [1]:
| https://en.wikipedia.org/wiki/Filial_responsibility_laws
|
| [2]: https://abcnews.go.com/Business/pennsylvania-son-
| stuck-moms-...
| OldTimeCoffee wrote:
| It's not cut and dry and it requires the company or state
| to sue. So 'can be' is very unlikely because the laws are
| not typically enforced. Federal law can also prohibit
| companies from collecting.
|
| More info is here:
|
| https://www.nolo.com/legal-encyclopedia/your-obligation-
| pay-...
|
| Because Wikipedia only talks about their existence, not a
| discussion of them.
| memling wrote:
| > It's not cut and dry and it requires the company or
| state to sue.
|
| I have to imagine that it's pretty rare, and I don't
| think it's appropriate to generalize from what appears to
| be a pretty sensationalist case. I expect the laws are
| usually structured to ensure that children don't fleece
| their parents out of money and turn them effectively into
| wards of the state, etc. It doesn't seem unreasonable to
| me that states would encourage families to take care of
| each other, though PA seems a bit of an outlier in this
| regard.
| OldTimeCoffee wrote:
| It's incredibly rare and PA is absolutely an outlier.
| That's why the case that is mentioned was newsworthy.
|
| Typically when it's used it's to recover money in cases
| of fraud. For example, where the parent or child
| conspires to hide money from the state to avoid paying
| for care. To the best of my knowledge, PA is one of the
| only states that allows private entities to sue. Some
| states are like Ohio where it's a criminal statute, so
| only the state has standing to bring charges. All said,
| don't get legal advice on the internet, this is an
| armchair discussion by laypeople.
|
| As an aside, I don't see why the children should have any
| specific burden to take care of their parents medical
| expenses now that we have Medicare and Social Security.
| We've decided it's better to have all of society to take
| care of our elderly rather than tie it to their
| children's ability to pay.
| Rebelgecko wrote:
| I believe the gift giver is the one who is responsible for
| any taxes (beyond the $11m threshold). Although if you give
| gifts as a way to get around debts it might cause issues
| drewg123 wrote:
| I could be wrong, but I thought that the $500K would not
| count as income for them, but would deduct from your
| lifetime estate tax exclusion. See
| https://www.nerdwallet.com/article/taxes/gift-tax-rate
| klodolph wrote:
| This depends on jurisdiction and the nature of the bills.
|
| Pennsylvania has filial support laws which mean that
| children can be held directly responsible for the medical
| expenses of their parents. This requires that Pennsylvania
| have jurisdiction over the children, of course.
| CameronNemo wrote:
| I've heard that only the parent needs to live in PA.
| klodolph wrote:
| This is incorrect.
|
| The parent does not need to live in PA at all, but a suit
| needs to be brought against the defendant to make them
| pay, and therefore the court needs to have jurisdiction
| over that person in order for the lawsuit to succeed.
| basisword wrote:
| Is this really true? American health care is a horror
| show but this is possibly the most messed up thing I've
| heard.
| rootusrootus wrote:
| True in some states. Also not just the US. Germany also
| seems to have some version of filial responsibility.
| klodolph wrote:
| Filial support laws are not even remotely unique to the
| US, and it's only true in certain states. Pennsylvania is
| the most notorious.
|
| France: https://fr.wikipedia.org/wiki/Obligation_alimenta
| ire_en_Fran...
|
| Germany: https://de.wikipedia.org/wiki/Elternunterhalt
|
| Asia has a ton, I'm sure.
| basisword wrote:
| It's the combination of filial support and the expensive
| US health care system that I'm shocked by, not filial
| support as a concept.
| klodolph wrote:
| Like other filial / familial support laws, there are
| limits based on the ability to pay.
| FireBeyond wrote:
| No, they're not. But hospitals, many times, will absolutely
| imply that they are when a parent dies in hospital.
|
| And if they do that well enough to have you make a payment,
| most legal systems will consider that acceptance of full
| financial responsibility on your part.
| prirun wrote:
| My Mom died in 2014, in a local hospital. Several years
| after her death, I received a bill from that same
| hospital, addressed to her but sent to my address, for
| $9K. The kicker is, the "service date" on the bill was
| 1996! I ignored it since a) she had died; b) she had died
| in their hospital, so they obviously knew; c) her estate
| had settled years ago; d) she never received this bill
| while she was alive.
|
| Hospital billing practice are pretty horrible. If a more
| compliant person had received this bill, they might have
| paid it, even though there is no way it was legit.
| nradov wrote:
| It depends on the state. Some states have filial
| responsibility laws which require adult children to support
| indigent parents.
|
| https://en.wikipedia.org/wiki/Filial_responsibility_laws?wpr.
| ..
| cherryturnover wrote:
| >In 2012, the media reported the case of John Pittas, whose
| mother had received care in a skilled nursing facility in
| Pennsylvania after an accident and then moved to Greece.
| The nursing home sued her son directly, before even trying
| to collect from Medicaid. A court in Pennsylvania ruled
| that the son must pay, according to the Pennsylvania filial
| responsibility law
|
| That is literally inheriting debt. That should be illegal,
| yet almost half the country allows this.
| klodolph wrote:
| It's mostly just Pennsylvania. There are something like
| 29 different states with some kind of filial support laws
| on the books, but Pennsylvania is the crazy one.
| runawaybottle wrote:
| Woah. And what if you had a terrible relationship with
| these people? What if you worked your whole life to get the
| fuck away from them?
|
| This reminds me of tobacco tax to pay for children's
| healthcare initiative. As if the responsibility sits
| directly with cigarette smokers. It sits on all of us, not
| one person. Impoverished elderly people that need medical
| care should receive aid from the state indiscriminately
| where we all foot the bill.
| plank_time wrote:
| This is jaw dropping. How is this legal at all?
|
| It sounds like a good startup. Do background checks on
| homeless people, see if they have any living relatives, and
| if so you can house them in a nursing home and charge the
| relatives.
| thechao wrote:
| They're legal because they're _laws_. I think you might
| be asking how they 're constitutional? They're
| constitutional because there's nothing in the
| constitution that prevents such laws.
|
| Are they fair? I mean ... sometimes? These laws
| (supposedly) solved a problem where parents would
| bequeath their estate to their children prior the
| parents' death and, then, the children would leave their
| parents destitute. It's not clear how much of a problem
| this really was (think "19th century); it was probably
| just a popular image that politicians used as a talking
| point?
|
| My suspicion is you'd need to use jury nullification to
| make the law "go away".
| 813594 wrote:
| While this strategy helps spend down to qualify for
| assistance near the end, all states have a lookback period
| that can disqualify you for state aide, and most look back
| periods are 60 months.
|
| https://www.medicaidplanningassistance.org/medicaid-look-
| bac...
| dharmab wrote:
| It depends on the bill and the state laws. E.g. debt
| collectors will use misleading and predatory tactics to get
| the children to pay "a token sum" that then makes the
| children liable for an entire debt.
| knz_ wrote:
| No, but they can legally take everything the estate has and
| leave the children with no inheritance.
| JMTQp8lwXL wrote:
| It's important to know some assets avoid probate and go
| directly to the beneficiary. These include things like a life
| insurance policy, or a 401(k) with a beneficiary information
| you can input, and possibly even update online (low friction).
| The health bill can go to the estate, but the estate also isn't
| comprised of the retirement account.
| mindslight wrote:
| You can setup a simple trust with the right form/software,
| and a visit to your bank for notarization. I don't know if a
| revocable living trust would protect your heirs against
| healthcare shakedowns, and it would likely depend on the
| state. But if the current corrupt system continues much
| longer, I can see irrevocable trusts becoming popular to
| protect yourself even while alive.
| slumdev wrote:
| This should be common knowledge (but, unfortunately, isn't.)
|
| A primary breadwinner should carry at least 10x his family's
| annual living expenses in term life insurance coverage.
|
| Once the size of his retirement accounts exceeds this, he can
| start thinking about reducing the insurance.
|
| Both will pay directly to beneficiaries in the event of his
| death.
| seandoe wrote:
| Without knowing anything, 10 million seems excessive, but 6
| months in a hospital will no doubt be expensive. I don't want
| to stir up bad feelings, I'm just curious, was there a good
| chance that your dad was going to make it out of the hospital?
| What was EOL talks like with the doctors? This story brings
| back the article here not too long ago, regarding the average
| hospital stay of a doctor at EOL vs the general public. I'm not
| sure of all the influencing factors regarding EOL procedure,
| but it does seem like a huge amount of resources are used for
| the very short end of a large amount of people's lives. Once
| again, no offense intended, it just got me thinking.
| t3rabytes wrote:
| Anecdata: I spent 5 days in ICU in 2018 and had a $350k bill
| from a California hospital, which my insurance company paid
| $200k for after adjustments and discounts. I wouldn't say
| $10m for 6 months is far off.
| seandoe wrote:
| Yea that sentence came off wrong. I don't doubt the OP's
| claim at all. I was trying to acknowledge that billing that
| amount to anyone isn't right and looking to make the point
| that healthcare is expensive and how "we" choose to
| allocate resources is an important discussion.
| irrational wrote:
| > imagine your life + childrens' lives being ruined
|
| A parent's debts cannot be put on to their children. Once your
| father died, anything not covered by his estate had to be
| written off by everyone.
| RobRivera wrote:
| true but what of inheritance? I suppose thats what life
| insurance policies are for.
| irrational wrote:
| OP said the father had no assets, so there was no
| inheritance forthcoming.
| dharmab wrote:
| If that had happened to my parents, my sibling who lives
| with them would have lost their home and had to move in
| with me. Just because OP's situation was different
| doesn't make that good.
| RHSeeger wrote:
| Bear in mind, this can happen to people that have a spouse
| and underage children. Spouse is decimated, children no
| longer have any help with collage (assuming they did before
| that). The family can be left destitute.
| DoktorDelta wrote:
| I'm not sure how many people know that though, and the moment
| you make a payment towards that bill it's legally your debt.
| simtel20 wrote:
| You are correct about the debt and the parent post clearly
| knows that, having lived through it'l. However the further
| point being that any assets that had accumulated with the
| intention of leaving them to the family, and which they
| relied on, would have been in jeapordy if they hit probate.
| If he owned a businessnor a house I'm not sure of the rules,
| but definitely savings, other assets etc. would be up for
| grabs.
| dharmab wrote:
| The rules vary by state and can change depending on if a
| written will exists.
|
| Parents, talk to an attorney while you're healthy. Some of
| the states have rules that will surprise you.
| legitster wrote:
| We took our son to an emergency room visit 2 1/2 years ago. The
| hospital was in network and we had insurance. It was a simple
| case of croup, we were out in a few hours.
|
| We just got a bill last month for $300. This was on top of 3
| other bills we have already paid over the years for the same
| visit.
|
| The insurance company said they only knew about it a few days
| before us. So it was a surprise to them too. But by nature of
| their agreement with the hospital, they were not allowed to fight
| it.
|
| I still wonder how many more bills we can expect.
| chris_wot wrote:
| Can this be right? " Two-thirds exit disclaimer icon of all
| bankruptcies filed in the United States are tied to medical
| expenses"
|
| From someone living in a country (Australia)with proper
| government medical support, this seems insane!
| tehwebguy wrote:
| Great but without legislation this probably goes away in ~3-5
| years
|
| Edit: I'm wrong, it's been legislated! Link in reply below
| justinc8687 wrote:
| This is regulation implementing legislation passed last
| year[1], so they should be relatively safe.
|
| 1. https://www.nytimes.com/2020/12/20/upshot/surprise-
| medical-b...
| bingidingi wrote:
| that's 3-5 years of some people not getting absolutely crushed
| by medical bills... which is still a huge win. Why is the "it
| will change in 4 years" argument so popular these days?
| vladTheInhaler wrote:
| Because it makes the point that congress is completely
| paralyzed on most major issues, largely because of of the
| filibuster. They are leaving it to the executive branch and
| the courts to effectively write the laws. This is an enormous
| systemic failure, and Democrats shouldn't be high-fiving
| because they kicked the can down the road a little way. Why
| do we even _have_ a congress if they aren 't going to
| actually legislate?
| [deleted]
| spaetzleesser wrote:
| I find it really hard to believe that US citizens are allowing
| this abuse and many even defend it. Markets may even be workable
| if the patient actually had necessary information and hospitals,
| insurers and multiple middlemen couldn't design these elaborate
| bureaucracies that are optimized to confuse people while
| extracting maximum money.
|
| I can't imagine any other industry getting away with this.
|
| I wish the Democrats had had any courage to go for Medicare for
| all. It's an established system that could be tweaked to expand
| coverage. Instead Biden will make some half assed moves which
| will immediately be obstructed by the republicans.
|
| And so this travesty will keep going for many years more.
|
| And it seems there is no hope for change.
| lotsofpulp wrote:
| >I find it really hard to believe that US citizens are allowing
| this abuse and many even defend it.
|
| Because US citizens know that increasing the amount of
| healthcare provided will increase taxes. This whole game is
| being played because we want to have our cake and eat it too,
| with many in the middle and upper deciles betting that they
| will be better off without a universal healthcare type system.
|
| >I wish the Democrats had had any courage to go for Medicare
| for all.
|
| We are lucky the Democrats are even trying, and that ACA even
| got passed, with the compromises that had to be made. They
| simply do not have the numbers in Congress (and will not based
| on population trends) to do any more.
| 8ytecoder wrote:
| There-in lies the problem. You overestimate the tax increase
| and underestimate what you end up paying if you ever get
| sick.
|
| And yes, the bigger issue is reducing hospital bills. Again,
| look at the line items and you'll see a big large number next
| to admin costs of processing insurance. Add the cost of
| profit for the insurance company and their cost of running
| the business and you know where this is going.
| chris_wot wrote:
| Then they know wrongly. There are plenty of countries who
| already have health care systems much better than the U.S.
| with similar levels of taxation.
| lotsofpulp wrote:
| Everyone in the healthcare chain in those countries earns
| less than in the US. The US is going down that road, but it
| will not be a quick and smooth.
| dntrkv wrote:
| For me, personally, I don't mind the increase in taxes but I
| do mind putting more money into a broken system.
|
| https://en.wikipedia.org/wiki/List_of_countries_by_total_hea.
| ..
|
| We spend more than 2x per capita than most other countries,
| and we don't even provide care for everyone.
|
| Infrastructure and schools face similar issues in the US. I
| don't know what the answer is, but dumping more money into
| these systems will only make them more inefficient.
| spaetzleesser wrote:
| "I do mind putting more money into a broken system."
|
| That's the problem with Obamacare. It just pumped more
| money into a corrupt system. The result is that premiums
| are going up like crazy.
|
| For the same reason I am against cancellation of student
| debt. If we don't stop the increases in tuition we are just
| shoveling money to corrupt institutions.
| inetknght wrote:
| > _I find it really hard to believe that US citizens are
| allowing this abuse and many even defend it._
|
| Your average US citizen has no choice in the matter.
| peter303 wrote:
| I would think you would need legislation to implement this rather
| than a regulation. The inurance-hospital-doctor lobby is rich and
| strong. When Colorado was considering a public insurance option,
| this lobby ran non-stop Fear TV commercials saying this new
| insurance would kill babies and seniors. (Despite seniors are on
| Medicare)
| dmeeker wrote:
| These regulations stem from legislation:
|
| > Today's interim final rule with request for comments
| implements the first of several requirements passed with
| bipartisan support in title I (the "No Surprises Act") of
| division BB of the Consolidated Appropriations Act, 2021.
| duffpkg wrote:
| I wrote Hacking Healthcare for Orielly, created ClearHealth, yada
| yada...
|
| Devil is always in the details of these rules but on the surface
| it looks like a good attempt. It is a sort of a bandaid though.
|
| To understand why this occurs know that most jurisdictions have
| certain staffing requirements for service lines. You must have X
| many neurologists covering X shifts. There is almost universally
| a shortage of these folks for other reasons, so you end up with a
| lot of non-staff doctors to fill the coverage requirements. Those
| non-staff often have different insurance relationships than staff
| doctors and so are "out of network".
|
| The two serious changes that would have a more durable impact on
| this are to free the lock the AMA has on residencies that
| exacerbates doctor shortages and to dramatically streamline the
| way insurance program enrollment is done for doctors. Further
| opening up interstate health insurance would also probably help.
| cool_dude85 wrote:
| >Further opening up interstate health insurance would also
| probably help.
|
| Can't wait to race to the bottom on this one. Which state wants
| to roll out the red carpet for insurers most? If I ever have a
| problem with Montana BCBS I'm sure, once I fly over, I'll be
| able to explain to the arbitrator in Butte exactly what my
| issues are and get a fair hearing.
| dahdum wrote:
| Wow, on the face this looks like a really great rule. I suspect
| there's going to be an ton of irate specialists (especially
| anesthesiologists) who were making fortunes from surprise
| billing.
| intricatedetail wrote:
| A lot of US policies were shaped by former Nazis. US healthcare
| and drug laws are just disguised eugenics. I am glad it is slowly
| being reversed.
| akeck wrote:
| Citation?
| [deleted]
| duxup wrote:
| It's straight up not possible to be an informed consumer in the
| US and avoid this stuff when it comes to health insurance.
|
| There's no market of rational decision makers, no choices you can
| make and really know the outcome when it comes to health
| insurance.
|
| My health insurance is pretty good and yet they randomly send me
| letters saying that they think the procedure should be covered by
| some other insurance they THINK I might have.
|
| In the meantime they stop covering things and the providers send
| me bills with no health insurance coverage ....
|
| They do this about every 18 months, I think hoping I just pay the
| bills and not notice.
| ihumanable wrote:
| One time I called my insurance to check if they would cover
| something that I could only find an out-of-network provider
| for.
|
| They said that I had out-of-network coverage after a $750
| deductible they would pick up 80% and I would be responsible
| for 20%.
|
| The out-of-network provider had quoted me $6700 for the
| service, so my responsibility should be $750 + (20% * ($6700 -
| $750)) = $750 + $1,190 = $1,940.
|
| I wasn't happy about having to shell out nearly two grand while
| having the best possible employer provided healthcare, Anthem
| PPO where we paid the most per month to have low deductibles
| and high coverage.
|
| At the end of the call, I tell the insurance company my
| understanding of what my responsibility is and what their
| responsibility is. Then they drop this on me, "Well we will pay
| 80% of the allowable price for the billing code the out-of-
| network provider submits."
|
| Good thing I asked, this was the first time they said anything
| about an "allowable price" so I describe the service and ask
| "what's the allowable price for that?"
|
| "Depends on how they code it"
|
| So I go back to the out-of-network provider and ask them for
| the billing code, which being a doctor that doesn't do their
| own billing, they have no idea. So I wait a few weeks to get
| back the billing code, and I'm back on the phone with my
| insurance company.
|
| "Hey, I have this billing code someone out-of-network will be
| doing, what's the allowable price on this?"
|
| "We can't tell you that, you'll have to submit a claim."
|
| "But when I submit the claim you will have this billing code
| and my member id and you will know the allowable price so you
| can figure out how much you are going to pay, you have that
| information now. What's the allowable price for this billing
| code, performed by someone out-of-network, with my plan?"
|
| It took them 2 weeks to come back and say that their "allowable
| price" was $1,658.
|
| So to summarize, it took me nearly two months of phone calls
| between myself, the insurance company, and the provider to find
| out what this service would actually cost. I only avoided
| accidentally getting hit by a massive surprise bill because of
| a combination of persistence and luck.
|
| It is nearly impossible to have any reasonable idea how much
| anything will cost, much less to comparison shop, when it takes
| months to get answers to basic questions.
| cwkoss wrote:
| Insurance billing practices should be criminal theft.
| ohples wrote:
| Universal Healthcare, free at the point of use.
| deregulateMed wrote:
| This doesn't solve the Taxi medallion system that physicians
| lobbied for to keep the supply of physicians scarce.
| SamoyedFurFluff wrote:
| It doesn't because it isn't meant to. That's a separate
| problem that can be tackled on its own merits.
| ohples wrote:
| Agreed
| spaetzleesser wrote:
| Just reliable and consistent pricing would go a long way. Right
| now they are doing everything they can to make the system as
| opaque and complex as possible. It's an elaborate system with
| traps designed to extract money from the patient.
| jaywalk wrote:
| Unicorns and lollipops available on every street corner, free
| to all.
| ohples wrote:
| If every other developed nation was able to provide unicorns
| and lollipops to its citizens regardless of their ability to
| pay, and the United States couldn't I would also be asking
| for Universal unicorns and lollipops.
| jaywalk wrote:
| Except that the majority of the unicorns are sick, and the
| majority of the lollipops have been licked by someone else.
| And when people point out that while we don't have them on
| every corner for free, at least what we do have isn't like
| that, they're ignored or called heartless.
| maerF0x0 wrote:
| I came from combo state provided, state paid healthcare system.
| The latter maybe ok, but never again to state provided. The
| service was/is horrible and health care providers are often
| complaining that they are angry their patients are receiving
| substandard care because the politicians are deciding procedure
| (via funding)
| codazoda wrote:
| I once called 911 when my wife had an Asthma attack that left her
| unable to speak or stand. She was transfered from an ambulance to
| a paramedic about half way to the hospital. My insurance covered
| one as in-network but not the other. My wife was released a few
| hours later. I was young and it took me about 10 years to pay off
| the dept I owed. I am extremely hesitant to call an ambulance if
| the person can be encouraged to move under their own power. So
| much so, that I was asked to sign papers when a family physician
| suggested an ambulance. This rule looks like it helps.
| hef19898 wrote:
| That is just crazy. Two years ago my son had a skiing accident.
| Was evacuated from the mountain by mountain guards, picked up
| by an ambulance, driven one hour to the next hospital, examined
| by a doctor and got an x-ray. 6 months later we received an
| invoice from our public (semi-public, the German system is
| peculiar) about 30 bucks (if memory serves well) for all of
| this. And that was mainly the longer distance ambulance ride.
|
| Nobody should be afraid of calling an ambulance. Nobody should
| need _ten years_ to pay debts for medical care, regardless of
| procedure.
|
| Another example, age 28 I was diagnosed with colon cancer. That
| meant a shit load of colonoscopies since then, removal of parts
| of the colon and 6 months chemotherapy. Overall bill: around 50
| bucks per months for the chemotherapy. Luckily I had
| supplemental insurance covering my salary, also my employer
| back then continued to pay after the legal 6 weeks. The risk
| you run in Germany is loosing your salary after 6 weeks, making
| that salary insurance so important. It is also dirt cheap, I
| pay roughly 15 bucks a month, it never increased since my
| studies. Health care should be a human right.
| vinay427 wrote:
| > we received an invoice from our public (semi-public, the
| German system is peculiar) about 30 bucks (if memory serves
| well) for all of this
|
| Honestly, it's remarkable how different it is here across the
| border here in Switzerland. An ambulance was called to me
| within the same city from a few km away (although I was
| across the street from the main hospital), performed an
| ECG/EKG on me, didn't pick me up or transport me anywhere,
| and I was billed about 700 bucks for that privilege.
| hef19898 wrote:
| I honestly wouldn't have expected that. There was a time
| when ranting about the German system was a favourite
| pastime, and there a lot of ridiculous and annoying things
| going on, but the more I learn about other countries I
| actually am quite happy, or better lucky.
| cure wrote:
| Ugh, that's horrible, sorry to hear that.
|
| Note that ground ambulances are _excluded_ from the legislation
| that Congress passed last year, cf.
| https://www.nytimes.com/2020/12/22/upshot/ground-
| ambulances-....
| LorenPechtel wrote:
| Yup--gotta let the mostly government funded ambulances shaft
| the patients.
| slownews45 wrote:
| No kidding.
|
| "Family Gets $18,000 Hospital Bill After Their Son Was Treated
| with a Bottle of Formula and a Nap"
|
| That kind of stuff stresses folks out!
| bonzini wrote:
| Wait, that's not the Onion?
| Forbo wrote:
| Unfortunately not. And at it happened at Zuckerberg SF
| General Hospital. Somehow seems inappropriately
| appropriate....
|
| https://abc7news.com/zuckerberg-san-francisco-general-
| hospit...
| kzrdude wrote:
| A good health system should deliver better quality of life to
| all the people of the country. That includes not just doing
| actual health, but acting as an insurance, giving actual
| peace of mind - _if_ something happens, it might not be the
| end of the world.
| asdfasgasdgasdg wrote:
| If it sticks, this is great! I wonder what law gives them the
| authority to just make a rule like this, though. I imagine the
| lawsuits about this issue will go for some years, as we have
| learned that the whole business model of some healthcare systems
| in this country is sticking users with these surprise bills.
| jbd0 wrote:
| What I do: Ask the doctor/PA/nurse how much EVERY LITTLE THING
| they want to do costs before they do it. Sure, it's really
| annoying and not 100% foolproof, but it has saved me alot of
| money.
| throwawayboise wrote:
| From the announcement:
|
| "Bans high out-of-network cost-sharing for emergency and non-
| emergency services. Patient cost-sharing, such as co-insurance or
| a deductible, cannot be higher than if such services were
| provided by an in-network doctor, and any coinsurance or
| deductible must be based on in-network provider rates."
|
| This to me seems to just completely eliminate the difference
| between in-network and out-of-network billing. What am I missing?
| dmeeker wrote:
| My read of the fourth bullet is that if you're receiving non-
| emergency service from an out-of-network provider, they can
| still balance bill you as long as you've signed the plain-
| language consent. (Presumably with such signature being a pre-
| requisite to receiving services.)
| jsmith45 wrote:
| Agreed. They are making in network and out of network the
| same from the the cost sharing perspective. To avoid screwing
| over out of network providers, they allow out of network
| balance billing, but only with consent.
|
| The actual rule also goes into things like consent to be
| balance billed for your knee surgery, is not consent to be
| balance billed for the ICU care when that surgery goes wrong
| and you nearly bleed out, and suffer major organ damage,
| etc...
|
| This consent option is not always available, an in those
| circumstances, balance billing is simply prohibited, and in
| network and out of network are fully equivlent in those cases
| from a patients' perspective.
| deregulateMed wrote:
| Hahaha I'm not holding my breath.
|
| It's multiple cartels vs us.
|
| These cartels have spent literally 2 billion dollars on lobbying
| politicians.
|
| So the real question is, how does this hurt us? How is this
| helping physicians build mansions, hospitals get record profits,
| etc...
| spaetzleesser wrote:
| Don't forget sports cars and yachts are expensive too.
| cwkoss wrote:
| With the number of mass shootings we have in America, I'm
| surprised I've never seen a story about a terminally ill person
| with astronomical medical debt going on a rampage at their
| insurance company's corporate office.
|
| Would probably make for a good movie concept - kind of a
| modernization of Falling Down.
| agentdrtran wrote:
| This doesn't hurt you directly, it's meant to placate people
| from demanding a substantial solution.
| aabaker99 wrote:
| > Bans other out-of-network charges without advance notice.
| Health care providers and facilities must provide patients with a
| plain-language consumer notice explaining that patient consent is
| required to receive care on an out-of-network basis before that
| provider can bill at the higher out-of-network rate.
|
| This seems like a really big loophole. I was just at the hospital
| for the birth of my daughter. My wife and I checked in at the OB
| desk where they asked for acknowledgment that we may be seen
| physicians that aren't part of the hospital (out of network).
|
| We acknowledged, so surprise medical bills are fair game now?
| golover721 wrote:
| Seems like a good step. Last year had to have a medical procedure
| done by an oral surgeon. For some reason there are no in network
| oral surgeons when it comes to medical insurance. Paid a
| significant amount up front. Painful but thought that it was all
| done.
|
| Six months later received an itemized bill for another
| significant amount. The worst part about it is theres no way to
| know if the bill is correct, or if insurance should of covered
| one of those line items. They really could just make up whatever
| they want as the system is so opaque, no one knows how much
| anything should cost.
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