[HN Gopher] Amid massive hospital sell-off, corporate giant cont...
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       Amid massive hospital sell-off, corporate giant continues suing
       patients
        
       Author : hhs
       Score  : 96 points
       Date   : 2021-07-26 17:43 UTC (5 hours ago)
        
 (HTM) web link (www.npr.org)
 (TXT) w3m dump (www.npr.org)
        
       | OrvalWintermute wrote:
       | It is not well-known that some large insurance companies have a
       | specific tactic that they employ against out-of-network medical
       | groups even for pre-approved or emergency work (Some practices
       | that are out-of-network will charge exponential multiples for
       | services which is another grievious issue).
       | 
       | The large insurer will send checks for goods & services directly
       | to the patient, rather than to the practice(s) that performed the
       | service, even if this is a fairly reasonable cost.
       | 
       | Patients see a check for $8,000 and $25,000 that is supposed to
       | go to the trauma surgeon's practice that initially stabilized the
       | patient, followed by the Plastic Surgeon's practice that spent 16
       | hours, 2 titanium plates, and a large number of titanium screws,
       | and biologic implants reconstructing the patient's face. And,
       | similar for the small consults $300 consults to Opthamology and
       | Neurology that are common to severe head trauma involving optic
       | nerves, relatively minor brain injures and significant facial
       | trauma.
       | 
       | Instead of providing it to the practice to pay for the
       | plates/screws, and delivered services, the patient spends the
       | money. Then the patient gets sued.
       | 
       | This is not uncommon unfortunately - even for medical practices
       | that TRY to be in-network with every single insurer, AND
       | medicare/medicaid.
        
         | wolpoli wrote:
         | I reread this twice, but I am still not sure how this helps the
         | insurance company through. Is there something I missed? Or is
         | this intend to cause administrative issues for out-of-network
         | medical groups?
        
           | OrvalWintermute wrote:
           | It puts the insurance company in the driver's seat when it
           | comes to negotiations, and it severely hampers the
           | administrative side of medical practice performing the
           | services, because they are in the awkward position of having
           | to sue a patient, or put liens/garnishments against a
           | patient's income/house. Insurance companies may not be at all
           | helpful in this process either.
        
       | Sohcahtoa82 wrote:
       | Hospitals suing patients to get them to pay medical bills is
       | something that could only happen in America.
        
         | asdfasgasdgasdg wrote:
         | Are there other countries where a person might be responsible
         | for their own bills? I think there are, right? This may be a
         | bit of a silly question, but how do the systems in those
         | countries collect from individuals who will not otherwise pay?
        
           | codegeek wrote:
           | " own bills"
           | 
           | The problem is that Hospitals can charge any amount they feel
           | is correct but you cannot find that out UNTIL AFTER the
           | service is delivered. Yes you _could_ ask for cash prices but
           | try doing that at a regular hospital and see how quickly you
           | get them in a clear and concise manner.
        
             | asdfasgasdgasdg wrote:
             | I'm replying to you because you're the top comment, but
             | this is a general response, because I feel like many
             | replies have misconstrued my meaning.
             | 
             | I am not asking what happens in countries with socialized
             | healthcare. I'm also not asking what are the flaws of
             | private healthcare. I am only asking, supposing that there
             | are other countries where there is private healthcare, how
             | those countries deal with nonpayment. If there are no other
             | such countries the question is moot but I had been led to
             | believe that there are some.
        
           | aaomidi wrote:
           | The same way America handles it when eventually enough people
           | don't pay. They bail the companies out with a ton of tax
           | payer money so the companies can continue their practices.
        
           | loopz wrote:
           | In many social democratic countries citizens will only pay a
           | small fixed fee for necessary operations. For private bills,
           | or if your travel-insurance doesn't cover medical bills in
           | other countries, you could still get stuck with a hefty bill.
           | 
           | In most cases, you pay peanuts and people get their health
           | back so they can go back to work and live life as before.
        
             | gruez wrote:
             | But GP was talking about countries in general, not just
             | wealthy western social democratic countries.
        
           | Sohcahtoa82 wrote:
           | In other countries, people don't get billed for their
           | healthcare, or the bill is small enough to be insignificant
           | for most of the population.
           | 
           | But we can't have that in America, because half the country
           | is convinced that would be _SOCIALISM!!_
        
             | asdfasgasdgasdg wrote:
             | I know that this is true for many other countries, but is
             | this in fact true for _all_ other countries?
        
               | markdown wrote:
               | Not all, but most.
        
             | tryingtogetback wrote:
             | Dangerously ill-informed comment. Have you ever been to a
             | hospital in a country that embraced socialism? In some
             | countries you pay effectively zero for socialized
             | healthcare. What an awesome, marketable for votes delusion.
             | 
             | Guess what. You get exactly what you paid for. Chronic
             | mismanagement, apathy, deteriorating conditions, lack of
             | resources. Need to schedule a procedure? Get into a virtual
             | line 10000 persons long. "Oh you are in pain? I'm sorry.
             | Thermometers are the only medication we can offer". In CIS
             | countries, the only way to get something done is to bribe
             | an official (to move you up the line by a 100 or so) or a
             | private clinic (but socialism is so great! right?) If a
             | country with socialized healthcare manages float it's
             | healthcare services on an "average" (aka meh) level, it's
             | only because of the private donors, private insurances,
             | private donations, and financial aid and subsidies from US
             | (but capitalism is so awful, right??)
             | 
             | Grass is always greener aka you have no idea what you are
             | talking about
        
               | parrellel wrote:
               | I don't think the countries of the ex-USSR are what
               | anyone is talking about when they're talking about
               | socialized medicine.
        
               | majormajor wrote:
               | I have - I had an emergency procedure done within hours,
               | without noticing particular mismanagement, apathy,
               | deteriorating conditions, or lack of resources.
               | 
               | It was annoying that they didn't want to give out
               | narcotic painkillers, but given addiction rates here,
               | understandable. Not a question of resources, just a
               | different approach.
               | 
               | Of course, as a foreigner who was going to have to pay
               | cash, I can't be positive that the experience would be
               | the same for citizens on Taiwan's national plan, but the
               | people I was staying with said I was being treated the
               | same as they'd seen anyone else...
        
               | 908B64B197 wrote:
               | > or a private clinic (but socialism is so great! right?)
               | 
               | Having to pay out of pocket after paying 50%+ tax rate!
               | Incredible!
        
             | themolecularman wrote:
             | To be fair America has the Veterans Affairs administration,
             | which is socialized medicine, albeit for a small subset of
             | the population, veterans.
             | 
             | If you recall from Donald Trump's presidency, one of the
             | things he campaigned on for veterans, is the ability to
             | choose your own healthcare, such that they wouldn't be
             | locked into the veterans affairs medical system, which was
             | found to be far insufficient.
             | 
             | This isn't an apples to apples but it's worth considering
             | that there are examples of the alternative model not
             | working in America either.
        
               | jodison wrote:
               | I, like many veterans, love the VA.
               | https://www.va.gov/opa/pressrel/pressrelease.cfm?id=5328
               | 
               | My understanding is that that the veterans' choice
               | private options would still have been payed for by the
               | VA.
               | 
               | https://www.va.gov/COMMUNITYCARE/providers/index.asp
               | https://www.politifact.com/truth-o-
               | meter/promises/trumpomete...
        
               | dragonwriter wrote:
               | > To be fair America has the Veterans Affairs
               | administration, which is socialized medicine, albeit for
               | a small subset of the population, veterans.
               | 
               | It also has TriCare (military & dependents, ~10M),
               | Medicare (Aged/Disabled, 61.2M in 2020), and Medicaid
               | (medically indigent, 68M in 2020). With around 9M in
               | Veteran Health Administration, the US has socialized
               | medicine for nearly 150M people out of the 330M
               | population.
        
               | jdmichal wrote:
               | Medicare and Medicaid are not exclusive. They call it
               | "dual eligible".
               | 
               | (PDF WARNING) https://www.cms.gov/Medicare-Medicaid-
               | Coordination/Medicare-...
               | 
               | This lists 20% of Medicare and 15% of Medicaid enrolled
               | are dual eligible. So the total, using your numbers:
               | 
               | 9 + (61.2 * .8) + (68 * .85) = 115 million
        
         | slownews45 wrote:
         | Totally false.
         | 
         | If you are in Caribbean country for example, and get services,
         | if you don't pay you will literally not be allowed to leave the
         | country until you settle up.
         | 
         | Generally the costs are fractions of what they are in the US.
         | But they are not playing - they don't have confidence that once
         | you are back in US or wherever that you'll pay.
         | 
         | Some countries even have exit fees etc. You are there until you
         | pay to leave.
        
           | kilroy123 wrote:
           | Lots of other countries do this as well, outside of the
           | Caribbean.
        
             | slownews45 wrote:
             | Yeah - they "arrested" the vessel I was on once until
             | someone's medical bill was settled up (not mine). Certainly
             | worked, company involved wired money promptly.
             | 
             | The other thing - you can be turned away for lack of
             | payment more easily (or just not get great care) in other
             | countries. In the US you can do a $10M bill on critical
             | care at a hospital without paying anything - that just
             | doesn't happen in some other countries in most cases - they
             | don't have the $10M lying around etc or have more competing
             | needs so you just can't stay on full support for years the
             | way you might in US.
        
         | [deleted]
        
         | fidesomnes wrote:
         | The only kind of hubris to get upvoted is ignorant anti-
         | American dunks.
        
         | renewiltord wrote:
         | Factually incorrect. Travel abroad to Germany, get care, and
         | then attempt to default on your bills. You will be threatened
         | with legal action.
        
           | ratsforhorses wrote:
           | And then what? They send it to some collection agency, who
           | sends you letters reminding you over 2-3 years...and..if the
           | amount is a couple of hundredEUR drop the matter...it'd cost
           | them more to pursue it further...
        
         | hereforphone wrote:
         | How many different countries do you hold law degrees (or even a
         | rudimentary understand of law) in?
        
       | mindslight wrote:
       | The article makes no mention of the legal justification backing
       | up any of these debts. They aren't due to straightforward
       | _contracts_ like nearly every other bill, as that would require
       | up-front rates. And so they must be due to some state law that
       | empowers hospitals to create arbitrary post-facto charges for
       | whatever amounts they feel like. Part of the focus of healthcare
       | reform needs to be on these state laws that enable the arbitrary
       | billing racket in the first place - if they were eliminated, much
       | of the opaqueness of the healthcare industry would be forced to
       | change.
        
       | henriquez wrote:
       | > But lawsuits are a rich man's game. She couldn't justify trying
       | to find an attorney or fighting a big, publicly traded company
       | that would pursue her for $2,700.
       | 
       | This makes no sense and calls into question whether the article
       | is being honest in its description of the debt in question. No
       | superior court would waste its time over $2,700 - that's small
       | claims territory, eg. no lawyers or fees for defendants.
       | 
       | In general if you owe a debt to a company that gets acquired the
       | debt doesn't just disappear. A bunch of fluff about the pandemic
       | doesn't change that either. So my take is that the lede is
       | disingenuous and the piece smells like agenda-pushing.
        
         | tssva wrote:
         | In my state and I assume many others the plaintiff can choose
         | whether to file in small claims or the normal general district
         | court. The defendant can file to have a case moved from small
         | claims to general district but not the other way around. Judges
         | also do not have the ability to move a case from small claims
         | to the normal general district process unless the parties
         | agree. Companies therefore usually file using the normal
         | general district process in other to achieve the very result
         | documented in this article.
        
         | kmeisthax wrote:
         | The _court_ doesn 't waste it's time; the _company_ does.
         | 
         | Furthermore, these sorts of bulk lawsuits can be used as scare
         | tactics to scare up settlements. _Obviously_ , prosecuting a
         | lawsuit over a $2,700 debt makes no financial sense _if_ you
         | were to carry the lawsuit to completion. But it _also_ makes no
         | sense to defend against. Just settle. The vast majority of
         | people do this and thus you can get lots of money by suing
         | people this way.
         | 
         | Indeed, they basically outright stated this:
         | 
         | "As of January, the company has decided to take patients to
         | court only if they make at least twice the federal poverty
         | level -- or about $52,000 annually for a family of four."
         | 
         | In other words, they target people who are most likely to
         | settle and pay up.
         | 
         | (Bonus points: this is intended to sound exonerating, until you
         | realize that there is no such thing as a "federal poverty
         | level". $52,000 is dirt poor in New York City or San
         | Francisco.)
        
           | gruez wrote:
           | >In other words, they target people who are most likely to
           | settle and pay up.
           | 
           | Seems like they can't win. If they sue everyone then they're
           | called out for "suing the poor" or whatever. If they sue only
           | people above an arbitrary cut-off then they're called out for
           | "target[ing] people who are most likely to settle and pay
           | up".
        
           | deathanatos wrote:
           | > _this is intended to sound exonerating, until you realize
           | that there is no such thing as a "federal poverty level"._
           | 
           | https://aspe.hhs.gov/topics/poverty-economic-
           | mobility/povert...
        
         | omegaworks wrote:
         | Who's going to take the time out to explain that to a
         | defendant? Certainly not the people trying to sue.
        
           | henriquez wrote:
           | If you get served with a small claims lawsuit it is clearly
           | labeled as such. And most small claims jurisdictions have no-
           | cost mediation options to help people understand wtf is going
           | on.
        
             | anigbrowl wrote:
             | _You_ know this, as do I. You are assuming everyone else
             | knows it too, and knows enough to say  'eat my shorts, file
             | a small claim or GTFO.'
             | 
             | It's not the job of journalists to educate folk in this
             | position, though a good journalist would point out such
             | relevant facts to assist readers of the article who might
             | be in a similar position nor or later. The primary job of
             | the journalist is to report on the situation of their story
             | subject, which might include a lack of financial or legal
             | literacy.
        
             | jermaustin1 wrote:
             | The threat of a lawsuit is not a lawsuit, it is instead a
             | demand letter that will state that if you do not pay, you
             | will be sued. It will not say in sued in small claims, it
             | just says you will be sued.
             | 
             | So you would not get served to appear at a small claims
             | court office, you will instead get a very scary letter on a
             | law office's letter head, and you will pay the money.
        
         | kirykl wrote:
         | They file suit hoping to get a no show default judgement, and
         | then file to garnish either wages or bank accounts. Most don't
         | contest so it's only filing fees on the plaintiff
        
         | travoc wrote:
         | I don't think that's correct.
         | 
         | https://www.columbiadailyherald.com/news/20191121/medical-de...
        
       | JumpCrisscross wrote:
       | > _When her summons arrived, panic set in for Cantwell.
       | 
       | "My mind went immediately to the stimulus payments," she says.
       | "At least I have a way to take care of this now."_
       | 
       | FFS. Zero chance this was a coincidence.
        
         | hereforphone wrote:
         | I don't understand your assertion. Were stimulus payments
         | instituted to indirectly pay the companies that own hospitals?
         | Will any further stimulus payments be issued with the same
         | motivation?
        
           | [deleted]
        
           | JumpCrisscross wrote:
           | > _Were stimulus payments instituted to indirectly pay the
           | companies that own hospitals?_
           | 
           | No. But someone noticed stimulus payments were coming, looked
           | up the debtors who owed amounts close to the stimulus amount
           | and sent off aides to harass those people into turning over
           | the money.
        
             | toomuchtodo wrote:
             | This is exactly what happened, due to a deficiency in
             | statute.
             | 
             | > Under the bill governing the second stimulus check, your
             | funds could not be garnished to pay debts like child
             | support, banks or private creditors. However, part of this
             | rule changed with the third check.
             | 
             | > The bill authorizing the third payout was pushed through
             | using a process called budget reconciliation. Congressional
             | Democrats used this legislative tool to more quickly pass
             | the new COVID-19 relief bill and the third stimulus check
             | that comes with it, since it allowed them to pass it with
             | fewer votes. But because this process was used, the third
             | checks aren't protected from all garnishment, although
             | lawmakers are moving to fix this now.
             | 
             | https://www.cnet.com/personal-finance/your-third-stimulus-
             | ch...
        
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