[HN Gopher] Majority of debtors to US hospitals now people with ...
___________________________________________________________________
Majority of debtors to US hospitals now people with health
insurance
Author : grecy
Score : 129 points
Date : 2024-01-11 18:49 UTC (4 hours ago)
(HTM) web link (www.theguardian.com)
(TXT) w3m dump (www.theguardian.com)
| jseliger wrote:
| It's very expensive being sick for any extended period of time; I
| had my first partial glossectomy surgery (removal of a piece of
| my tongue) in October 2022
| (https://jakeseliger.com/2023/07/22/i-am-dying-of-squamous-
| ce...), and there are at least three major components to being
| sick for a long time: health itself; financial viability; and
| managing the healthcare team.
|
| I've been lucky with the generosity of friends and strangers
| regarding the second one due a successful Go Fund Me, but I've
| also gotten walloped with some gnarly bills, most notably for
| Signatera blood tests for cancer particles and for genetic
| testing of the tumor itself. United Healthcare considers those
| experimental and thus uncovered. But the genetic testing of the
| tumor is essential because it might lead to targeted treatments.
|
| Legislation has supposedly limited surprise out-of-network bills,
| but, even with insurance, costs can be very high, and those
| combined with not being able to work effectively leads to
| problems.
| plagiarist wrote:
| I'd like to see insurers be sued for malpractice since they
| feel entitled to make medical decisions for people.
| beaeglebeached wrote:
| That will raise the price of insurance even more. Now you
| have to cover the cost of risk of suing your own insurance
| pool.
| plagiarist wrote:
| Alternatively, they could consider not having lone
| employees mass-denying procedures from a spreadsheet. Or at
| least stop using the AI that gets it wrong so often it's
| indistinguishable from intentional.
| beaeglebeached wrote:
| I think biggest problem is health insurance is now more
| like a weird HSA where insurer owns the money and
| operates as cartel. It might be cheaper for some to not
| even have it and just go to Mexico, maybe some minimal
| insurance only for emergency room.
|
| Hard to call it insurance, when so much used for known
| chronic ongoing costs.
| tenebrisalietum wrote:
| A friend of mine had gastric bypass revision surgery in
| Mexico because it was cheaper.
| wing-_-nuts wrote:
| As opposed to a single 'doctor' mass denying 1000's of
| requests a day? That should be illegal.
| beaeglebeached wrote:
| Profit margins are like 4% on health insurance. Insurance
| companies introduce a lot of cost and waste, but there's
| no evidence to me these mass denials are anything but the
| market not bearing real insurance that covers things
| reasonably under current regulatory conditions.
|
| Could it be the consumer is too poor to pay for a bloated
| system that covers what it does, plus the mass denials?
|
| The whole system is fucked and the even more fucked part
| is mass denials may be a symptom of the madness of the
| inefficient rube Goldberg machine and not even a profit
| driver.
| antisthenes wrote:
| > Profit margins are like 4% on health insurance.
|
| If I tell you my cost of a bottle of water is $96,000 and
| sell it to you for $100,000 in the middle of the desert,
| my profit margin is only 4%.
| Kon-Peki wrote:
| It's probably impossible to know the full extent of this, but
| some percentage of hospital debt comes from people that can fully
| afford their healthcare but are using the payment plans as no-
| interest loans while their money is invested elsewhere. The HSA
| accounts you get with the high-deductible plans allow you to park
| the money in self-directed IRA accounts _for your entire life_.
| In fact, tax law encourages you to do this.
| zepton wrote:
| I don't think amounts that are on a payment plan would qualify
| as "bad debt" though - if someone is paying as agreed on a
| payment plan the debt isn't uncollectible.
| Kon-Peki wrote:
| Yes, very good point. However...
|
| The linked report states:
|
| > And as sudden operational cost pressures (including nursing
| shortages and higher wages) frustrate hospital financial
| leaders, an inability to collect all expected revenue further
| challenges razor-thin operating margins.
|
| > This increase creates new challenges for providers to
| collect higher balances that are more difficult for patients
| to pay either prior to services or during the typical 120-day
| collection window after the insurance balance has been
| resolved.
|
| I think they are being intentionally vague here. Are they
| saying they're having trouble collecting the money within the
| 120-day window (so their quarterly reports aren't screwed),
| or ever? I feel like they want you to believe that it is the
| latter, when in fact it is the former.
| marcus0x62 wrote:
| I'd like to know the full extent of this. I'd eat my shoe if it
| was more than a tenth of a percent of outstanding healthcare
| debt.
| tiahura wrote:
| It's called a deductible.
|
| People don't pay their bills anymore, unless they absolutely have
| to.
| Supermancho wrote:
| Generally this is true. For anything over a thousand, I try to
| negotiate. Most of the time they rather compromise than
| fight/sell it at a % to collections.
| robterrell wrote:
| How exactly do you negotiate? After you get a bill, you call
| their billing number and just ask for a lower number?
| Supermancho wrote:
| I have simply had to say, I can't pay this* (*despite the
| fact it's simply violating my budget). What's the process
| for after a bill's due date expires? Sometimes the response
| is: it gets a penalty added. I reply, I can't pay that
| either. Can we work something out? Usually, I get connected
| to someone who will either offer a discount or payment
| plan. Sometimes this isn't going to be any better (payments
| for the total amount over time), but it's often interest
| free...since the whole point is that you can't manage it.
| Sometimes they are firm and say it will go to collections.
| At the heart of it, it's a matter of game theory. You don't
| get 100% of the discounts you don't pursue.
|
| For my health provider, I currently have an otherwise
| unmentioned number I can call for my medical bills that I
| can pay immediately, that gets me 25% off whatever the bill
| is. I would never have known about it, had I not said I
| couldn't pay a particularly large one.
| ch4s3 wrote:
| Yep, that's basically it.
| aantix wrote:
| I'm curious too - what's your best strategy for lowering?
| darth_avocado wrote:
| I have good insurance and I have unpaid medical bills for the
| following reason:
|
| 1. Visited a doctor 4 months ago, got a bill 3 months after the
| visit, paid it, then got a surprise second bill, which I have put
| off paying because I need to find time during my work hours to
| follow up on with the hospital + insurance.
|
| 2. Didn't get bills for some of the visits I made in the last 3
| months.
|
| 3. Insurance randomly denied claims, so need to follow up with
| them and the hospital.
|
| 4. Despite insurance covering 70-90% on different services, one
| visit for my spouse cost us thousands. We decided to pay it off
| as installments instead of one time because we got a really good
| deal.
| throwway120385 wrote:
| This was us for my wife's pregnancy and delivery. Some of the
| bills were denied by Cigna for things that were covered
| according to their book. So we had to fight that. Cigna can
| take months to reprocess claims, which basically puts you into
| default with the hospital while you wait for the insurance to
| pay out for services that were supposed to be covered. We've
| done this after every medical event because Cigna always denies
| something that should be covered. And their accounting system
| doesn't work correctly which is something that is constantly
| your problem because they won't accumulate your out of pocket
| max or coinsurance correctly, so you CONSTANTLY have to call
| them about everything because it's always wrong.
|
| Cigna is the worst insurance company I've ever had the
| displeasure of dealing with. United Healthcare was slightly
| better but only slightly.
|
| For a surprise bill, my wife got fired as a patient by the
| biggest clinic network in our area for a bill that she didn't
| know she had and that the agent she talked to wouldn't provide
| any evidence or itemization. The agent's response when asked
| was "you know what this is for you should just pay it." Sounds
| scammy, right? They keep buying clinics we're going to and then
| she stops being able to see her doctors afterward.
|
| Private equity is destroying our healthcare system.
| darth_avocado wrote:
| Cigna was also the culprit in our case for stuff where
| covered items were being rejected for no reason.
| taeric wrote:
| That has included me, in the past. It is stupid easy to
| accidentally have a debt to a hospital. For families, sensible
| privacy rules at clinics can mean that it is very hard to choke
| point bills to a single person. To the point that I asked every
| time if I owed money when I did checkups to be told that we did
| not. Only to later find that my family did, in fact, have a bill
| due. For a while.
|
| Recently I'm getting it with the stupid "anesthesia is billed
| separate from the surgery" nonsense. At least this time I noticed
| the bill. Why is that not a single bill, though? Imagine having
| to pay the cook, cleaner, server, and attendants all separately.
| So frustrating.
| retrac wrote:
| I would point out that the attending surgeon, the
| anaesthesiologist, and the hospital all bill the patient
| separately here for a surgery, in Ontario, Canada. (Most people
| will never see these bills and it's covered by the public
| insurance.)
|
| The reason is that the service - the contract - is organized in
| that way. Between the patient and the anaesthesiologist,
| between the patient and the surgeon, and between the patient
| and the hospital. So three separate bills. The doctor and
| hospital will have their own contract. Legally, and in an
| important way when it comes to decide who to sue for
| malpractice, the hospital is not the provider or performer of
| the surgery. They just provide the venue and equipment; the
| doctors do the surgery.
| taeric wrote:
| This doesn't endear me to the situation. :(
| AlecSchueler wrote:
| But why is done that way? Lots of freelance chefs move
| between restaurants but the bill is always between the
| restaurant and the people who dine there.
| beaeglebeached wrote:
| Server is better analogy. The wage you pay/owe the waiter
| is direct and (mostly) separate from meal, albeit informal
| with only shame as a deterrent for default.
| AlecSchueler wrote:
| I'm not based in the US, so my servers are paid a wage
| directly by the restaurant.
| beaeglebeached wrote:
| That makes sense, but the _ah ah ah this isn 't the US_
| card comes unexpected on an analogy developed
| specifically alongside a US based topic.
| John23832 wrote:
| Because the legalities of chef/restaurant malpractice are
| orders of magnitude less important than those of
| doctor/anesthesiologist/hospital.
| devilbunny wrote:
| Because historically doctors were in private practices. I
| still am, as an anesthesiologist. Many of the surgeons I
| work with are also private.
|
| So, since neither of us is employed by the hospital, we do
| our own billing. If we _were_ hospital employees, we could
| indeed do unified billing. That 's a better analogy; your
| chefs are expecting to be paid by the restaurant, so it
| collects the bill. I am _not_ paid by the hospital except a
| stipend for taking call for them - not for any specific
| services I provide to patients.
|
| It's frustrating for patients and families, it's annoying
| for us, but it's the price of legal independence for us. If
| my hospital collapsed overnight (and they sometimes do), my
| group could go out and start working other sources of
| income right away, because we already have the business
| setup to do our own billing.
| petre wrote:
| It's still better than billing to the hospital and the
| hospital billing to the patient, piling up taxes and
| comissions. The patient is also getting more cost
| transparency instead of a bundled bill one can never make
| sense of.
| ddoolin wrote:
| I don't agree with the last point and I think this thread
| is evidence of that. We cannot make sense of the myriad
| of bills we get from all the different providers,
| particularly since many or all of them are also being
| dealt with by our insurance and may have already been
| negotiated by the time we get the bills in the mail.
|
| To that point, I went to the ER a few months ago and I've
| probably received ten or so mailings for unpaid bills,
| only one of which I actually ended up owing, but my
| insurance didn't make the claims visible until they were
| settled which was months after the fact. To make matters
| worse, I can _still_ log in and pay bills which were
| settled by my insurance. And I 've received bills in the
| mail -- late I assume -- after they were paid by me or
| settled by insurance, confounding matters further.
| Aloisius wrote:
| Transparency would be far more useful if it came _before_
| the service being rendered.
|
| Obviously there are some practical limits in exceptional
| cases, but I can't think of another industry that has
| high-price services where providing estimates isn't
| standard.
| plagiarist wrote:
| Not seeing these bills would be incredible. Having them all
| covered in the same way would be fantastic. Instead, for us,
| states need to enact surprise billing laws since each
| provider can mysteriously be out-of-network despite working
| within a hospital that is in-network. The in-network concept
| is complete bullshit to start with, but then you have to have
| complete documentation of every person involved in whatever
| care you are getting.
| plants wrote:
| This is what infuriates me the most about healthcare in the
| US. I give someone my card, they enter the numbers with no
| indication of whether or not everything will be covered by
| insurance (they assume you just know).
|
| Then, a month later, I receive a bill indicating a routine
| procedure that I assumed out of ignorance was covered by
| insurance (since they took my card and entered the numbers
| without saying anything to the contrary) for $500 (or, god
| forbid, more).
|
| If I knew a salad at a restaurant were $200, I probably
| wouldn't order it. There is no basic transparency in
| medical billing, and that needs to change.
| jimmygrapes wrote:
| Sounds like the way hair salons and strip clubs are run in
| the U.S.
| hotpotamus wrote:
| It all feels quite postmodern to me; like it's all made up as
| you go along. Try to ask how much something is going to cost in
| a medical context and they'll usually look at you like you're
| stupid (and I mean like a shoulder x-ray, not something that
| involves a team of people and maybe some unknowns when they cut
| you open). Well fine, but if you can't tell me how much
| something is going to cost, then I can't tell you if I'm able
| to pay it, so I guess we'll find out together.
| ahi wrote:
| I've been getting those separate bills recently and it's
| driving me nuts. For one small out patient procedure I have
| received bills from the hospital, the doctor, the
| anesthesiologist, anesthesiologist nursing company, and a
| random surgeon I have never met that the doctor asked in for a
| 30 second consult (I know how long the procedure took) while I
| was under. Seriously considering ignoring some of these whotf-
| are-you bills out of spite.
| freetime2 wrote:
| > Seriously considering ignoring some of these whotf-are-you
| bills out of spite.
|
| Then they will sell your debt to a collections agency who
| will make it their business to harass you to the maximum
| extent legally allowed (and sometimes more than that). This
| may include impacting your credit score - although I think
| some states at least have protections against that.
| toomuchtodo wrote:
| https://www.consumerfinance.gov/about-us/newsroom/cfpb-
| kicks... ("CFPB Kicks Off Rulemaking to Remove Medical
| Bills from Credit Reports")
|
| https://www.consumerreports.org/money/debt-
| collection/fight-... ("How to Fight Back When Contacted by
| a Debt Collector for a Medical Bill")
|
| https://www.patientadvocate.org/
| Buttons840 wrote:
| I'm surprised medical billing scams aren't rampant,
| considering it's 100% normal to have a bill from from an
| unknown company show up asking for payment for unclear
| reasons for a procedure done a year ago.
| NoMoreNicksLeft wrote:
| > I'm surprised medical billing scams aren't rampant,
| considering it's 100% normal to
|
| The difference between honest-to-god scams, and just these
| meaningless me-too bills that accompany every medical
| procedure or test... well, is there a difference?
|
| If a scam is some scheme or trick to get you to pay for
| something you never agreed to pay for and wouldn't agree to
| pay for if it were said up front, through deception
| strategies like opaque policies and maneuvering you to a
| point where you can no longer back out of it...
|
| Then pretty much all of it is a scam. That the people
| performing the scams have professional degrees in medicine,
| that they're gainfully employed as hospital and medical
| company employees, and so on, that doesn't really change
| the nature of it.
|
| Originally, the "scammy" behavior was developed (and not
| deliberately) to try to coerce the insurance companies into
| paying. But the insurance companies could afford employees
| to counter all those tactics. This didn't mean the experise
| was wasted though, they simply turned that onto the
| patients themselves.
|
| The crazy thing to remember is that none of that expertise
| will go away, no matter what happens. Maybe they'll turn it
| on the government too, at some point, if we ever get
| universal healthcare. That could be a hoot, couldn't it?
| verisimi wrote:
| Isn't the whole thing a scam? Top (legislation) to bottom
| (little gripy socks, as per another commenter).
| freetime2 wrote:
| I agree this is so frustrating. One thing that I've found in
| the US is that in addition to having fewer out of pocket costs,
| being on an HMO plan can significantly simplify billing vs a
| PPO plan. We switched over to an HMO plan from PPO during my
| wife's pregnancy and we went from getting a new bill in the
| mail every week to just paying a fixed co-pay at the doctor's
| office every visit. It saved us so much stress, and in our case
| we were able to keep the exact same doctors, facilities, etc.
| We also saved a bunch of money, but the simplicity ended up
| being the thing that I valued most.
|
| Years after our child was born, I ended up getting a scary
| letter from a collections agency. Turns out I had missed some
| $20 bill from the time when we were on the PPO plan. So they
| say, at least - it seems equally plausible that it was a
| billing error on their side (of which we found many), and they
| never once mentioned it during any of our visits. But at that
| point I was not willing to fight over $20 and just paid it.
| wing-_-nuts wrote:
| One thing my mom has been dealing with recently is where the
| insurance EOB and the bill differs substantially. My mom called
| the hospital to ask for an explanation and _poof_ the bill is
| magically lowered by a several hundred dollars.
|
| How the heck is this not criminal fraud? Why are people allowed
| to simply bill whatever they feel like it, and why is my mother
| getting 'balance billed' for random amounts? They're still
| doing all this dirty underhanded stuff and when they get called
| out on it, it's 'Oopsie! Our mistake' when they know most
| people they do this to will naively pay it
| FireBeyond wrote:
| Depending on the state you are in, balance billing can be
| outright illegal, and, in many cases, despite facilities
| potentially trying to get you to sign a waiver against your
| protection from balance billing, that right can't be waived
| except in limited circumstances.
| toomuchtodo wrote:
| https://www.cms.gov/newsroom/fact-sheets/no-surprises-
| unders...
| forward1 wrote:
| > How the heck is this not criminal fraud?
|
| It may surprise you to learn criminal fraud occurs on a
| regular basis and the simple act of acknowledging it does
| nothing to address it.
|
| > Why are people allowed to simply bill whatever they feel
| like it
|
| Pretty simple economics: they have something you want
| (healthcare) which no one else can provide. Supply and demand
| - they dictate the terms.
| _jal wrote:
| Yeah, they play this game enough that I simply question
| fucking everything. They will explain every single bill in a
| way that I can map back to a timeline, or they will take it
| off.
|
| This has to be done in person, where they can't be, uh,
| accidentally disconnected, but I've found the rate-of-return
| on that time hard to beat. They discover all sorts of
| "mistakes" when you're taking up their billing specialists'
| time.
| redleggedfrog wrote:
| I, and my family, are now literally asking on every single
| thing, "Is that covered by my insurance? Will I be billed extra
| for that?" Like, over and over. Stupid system, stupid
| questions. At a recent minor surgery I must have asked it 10
| times, and once for these little grippy socks they wanted to
| give me for my bare feet. And yup, they cost extra. So, get 'em
| out.
| beaeglebeached wrote:
| Hospital said I owed debt. Contested claim with debt collectors.
| Never saw it again and not on my credit report. Know a few people
| who've done this.
| tlivolsi wrote:
| My friend did the same thing.
| Turing_Machine wrote:
| While not great, things are a little better in this area than
| they were a few years ago.
|
| 1) Even if it goes to collections, a medical debt won't appear
| on your credit report for a full year.
|
| 2) Medical debts less than $500 won't _ever_ appear on your
| credit report.
|
| 3) If you pay the debt off later, the entire thing gets
| expunged from your credit report (i.e, rather than showing you
| had a debt that went to collections, and then was paid off,
| it's like the whole thing never happened).
|
| These things only apply to medical debts, though, not normal
| consumer debts.
|
| (edit: list formatting)
| paxys wrote:
| Every single debt should be contested. "Oh but I know I owe
| this". How do you know you owe it to that specific collector?
| Can you be sure it wasn't sold twice? Can you be sure the
| company didn't already write it off? Can you be sure that
| paying it means it'll actually be marked paid in their system?
|
| The entire debt collection industry is a mess, and only the
| absolute worst players operate in it. If you try and stay
| honest and moral you _will_ be taken for a ride.
| nineplay wrote:
| This is the kind of headline you have to be careful with because
| as long as there's debt there will be a majority of debtors.
| Without raw numbers, this could mean more insured people are
| getting into debt _or_ it could mean that the US has gotten
| better at providing cost-effective health care for the uninsured.
| If that's the case, than this headline is something to be
| celebrated.
|
| Let's say last year 100 people were in debt to hospitals - 40
| insured, 60 uninsured.
|
| This year 70 people are in debt to hospitals - 40 insured, 30
| uninsured.
|
| Great!
|
| (I know that it would be much better if no one was in debt, but
| that's a separate discussion.)
|
| (Also possibly fewer uninsured people are in debt because they
| all died of treatable conditions but that conclusion will have to
| wait on more data.)
| tptacek wrote:
| This is the only debt I have, because hospital payment systems
| are fucking impossible to navigate. Thankfully, the Biden
| administration is drafting plans to make it unlawful to report
| that debt to credit reporting agencies, so I anticipate soon
| giving even less of a shit about it than I do now. Figure it out
| with my insurer, or bill me at the time of service. I'm sure as
| shit not responding to an invoice.
| mtlynch wrote:
| I'd love to adopt this strategy as well, but I worry about the
| clinic eventually forcing me to pay somehow and adding a bunch
| of penalties on top. Is there a way to mitigate that risk? Or
| is that risk unlikely in a way I'm not considering?
| tptacek wrote:
| I'm not a lawyer, or a financial advisor. So: they could in
| theory sue you. But they're doing this to _everybody_ , so
| unless you think they're going to sue everybody, I think it's
| a pretty safe bet? This has been my stance for over 10 years.
| I'll gladly pay if you ask me up front (or on the way out).
| Otherwise, fuck off.
|
| I get how this attitude could sound shocking. I have friends
| who take a similar approach to other things and get away with
| it; most notably, a friend who refuses on principle to pay
| parking tickets. I _pay_ parking tickets, and I still get
| whomped every 5 years or so with some absurd backlog of
| missed tickets and a boot, so I don 't understand how this
| works for them. But it does!
|
| You probably don't want to get me started on credit scores.
| toast0 wrote:
| First off: I suggest you pay any reasonable bills you know
| you incurred and can pay. Don't be a deadbeat. That said...
|
| As I understand it, it's pretty typical for these bills to be
| sold, and once that happens, the originator doesn't really
| care anymore. They got what they got and it's written off.
| _Maybe_ they won 't see you anymore, because you don't pay
| your bills; maybe they don't really care because lots of
| people don't pay their bills; if they were smart, they'd bill
| you at time of service, but chances are they're not
| organizationally capable of billing at time of service. _If_
| they won 't see you anymore _and_ you have limited options
| for medical care or they 're the best option for medical
| care; you'll need to settle up. If not, the clinic has no
| means or desire to force you to pay.
|
| The debt collectors have a time limited option to take you to
| court for repayment, but most of the bills aren't worth the
| effort, so you can probably wait it out. It might ding your
| credit, but if it comes up, you say 'hey, this bill correct'
| and it's a medical bill and everyone believes you.
|
| If the debt collectors do file a suit, and you have the money
| to pay, negotiate a payout then.
| hanniabu wrote:
| because insurance doesn't pay full amounts, and often are left
| with a larger bill than if you didn't have insurance due to the
| "insurance premiums" that are charged because they know insurance
| won't approve the full amount
| nonameiguess wrote:
| The definition is amusing. "Have the ability to pay but don't."
|
| They don't exactly make it easy. I'm usually good about this but
| am probably on this list right now. My cat got out of the house
| and bit me on the hand last year around this time and it got
| infected and swelled up. Went to one of those boutique ERs with
| no wait, which I specifically did _because_ I have plenty of
| money and can pay. They still couldn 't bill me everything on the
| spot.
|
| Four months later, when I got the rest of the bill, which is only
| $117, I tried to pay online and their website said my account
| number was invalid. It's the number on the bill _they_ sent me.
| So I tried to call to pay and the payment center apparently is
| staffed by one person and if you call when they 're at lunch,
| you're out of luck. It can be paid by mail, but they don't
| provide postage and I last sent mail on purpose on any regular
| basis over a decade ago and don't have any stamps.
|
| So oh well, suck it. I'm not going through that much more effort
| to pay you $117. If you're seriously willing to sell that for $2
| to a debt collector, have fun. Even if I ultimately pay, the
| labor and paperwork on behalf of all involved parties is probably
| enough that every single participant loses money.
| petre wrote:
| > My cat got out of the house and bit me on the hand last year
| around this time and it got infected and swelled up.
|
| Always have betadine on hand. My cat scratched and bit be
| numerous times, never had an issue, always washed with plenty
| of soap and water and disinfected the wounds with betadine.
|
| Indoor cats also go crazy. I'm never keeping another cat
| indoors without free roaming access.
| aantix wrote:
| Do the debts get reported to the credit bureaus if you don't pay?
| hospitalJail wrote:
| I bill Blue Cross Blue Shield and the cost of a service was $125.
|
| A different insurance was $70.
|
| The medicaid patients are $40 (and our company would collapse if
| we only had these patients). They are basically break even, or a
| loss when they call off.
|
| Now we aren't part of the hospital or physicians cartel, we are a
| tiny offshoot with no lobbying power... yet. Medical is a legal
| squeeze, not a technical one. Sorry for playing the game too. You
| need to fight against Medical.
| black6 wrote:
| The cool thing about health insurance is that you pay a lot of
| money every month, then when you get sick or injured you pay a
| lot more money.
| JohnMakin wrote:
| I have been fighting these battles for much of the last ten years
| and this article fails to explain a dynamic that is happening
| here, at least where I am (california).
|
| I'll give my most recent thing that ended up in collections
| (which you can easily ignore, it doesn't affect your credit at
| all in some states). I had a pretty intensive surgery. I had a
| copay, which was shown to me before the surgery. I signed it,
| paid, think everything is good.
|
| However, in the background, which happens often, the insurance
| company and the hospital/doctor are still haggling about who owes
| what. Eventually they can't come to a decision, and the hospital
| punts it to the patient or collections. Even better - say you do
| pay this "surprise" bill. Sometimes the insurer eventually pays
| up. Guess what happens then? Does the doctor/hospital notify you
| then that you overpaid? Very rarely. For me it was a $800 bill on
| top of the thousands I already paid _for anasthesia_ (and some
| other stuff).
|
| Hospitals and insurers are putting patients in the middle of
| their disputes and it rarely ends up well for the patient.
| Hospitals acting like they're somehow the victim here is
| extremely rich from my perspective, they are at least half of the
| entire problem.
|
| I recommend letting them go to collections and then disputing it
| there. Lots of times these collections agencies use shady
| practices that give you some good leverage, or it's a double
| billing scenario like I described above.
| onlypassingthru wrote:
| I recently had success using CA's Dept of Insurance to assist
| me in convincing a health insurance company to pay a health
| provider what it says on my policy. I filled out the form
| online[0] and in less than a month, the insurance company
| decided to pay the full amount I expected. I only wish I had
| used the DOI service sooner as I wasted _months_ getting
| shuffled between insurance company departments in their never
| ending quest to make me go away.
|
| [0]https://www.insurance.ca.gov/01-consumers/101-help/index.cfm
| alwa wrote:
| Buried midway down, they mention that the commercial health plans
| available to people without conventional employers (Obamacare)
| can (and routinely do) set deductibles as high as $9,450. And
| that's _in addition to_ the premium-which, in New York City for
| example, starts at $618 /month for the very worst plan for an
| individual. Sure, that's subsidized for lower-income households
| -- but who among those has a spare $10K lying around to spend out
| of pocket before they actually benefit from the insurance?
|
| When you've budgeted the $7,400 to pay for premiums whether or
| not you use healthcare, and the insurance doesn't even kick in
| until you've spent a total of $16,800 on medical care in a given
| year, it doesn't come as a huge surprise to me that people feel
| like they've already paid enough, and that the payers and
| providers should sort it out amongst themselves.
|
| There's economic, contractual, and policy reality; but then, even
| among people who might be able to afford it, there's the gut
| feeling of "I've already paid way too much for this 5-minute
| checkup, I'm not paying more."
| slfnflctd wrote:
| We should've gotten single payer. The insurance lobby is just
| too strong, I guess.
|
| In several recent years, I would've been better off not having
| insurance and paying out of pocket because I never (or just
| barely) hit the deductible. Even when my deductible was lower,
| if you added up my premiums against what was covered I still
| probably overpaid most years. So all I've been doing is
| subsidizing someone else's bills while paying my own on top of
| it.
|
| Yes, I know this is how insurance works, but it doesn't feel
| great to keep paying out so much money while getting nothing
| for it but vague promises they likely won't have to keep which
| expire every year.
| paxys wrote:
| Insurance companies are very much to blame, sure, but that
| doesn't change the fact that >50% of the country rejects
| these systems because "socialism". If we can't get over that
| hurdle first then nothing will ever change.
| paxys wrote:
| Obamacare was essentially gutted when the individual mandate
| was deemed unconstitutional and removed. If young, healthy
| people aren't signing up and paying into the system then of
| course the sick ones will bear the brunt of it. That's just how
| insurance works.
| charonn0 wrote:
| I've been contacted by collection agencies over an ER bill that I
| paid up front and in full. The system isn't even designed for
| that possibility.
| GrinningFool wrote:
| At any given time I have a few hundred dollars of unpaid medical
| bills because they are so inconsistent. Some don't show up for
| months. Some show up right away. Some are tracked in the
| providers' proprietary apps. Some are sent by mail.
|
| Some, I don't learn about until they're in collections. Did I
| miss an email/notification/mail? No idea and no way to tell.
|
| Incredibly frustrating situation.
| duffpkg wrote:
| This seems like a good thread to mention the book "Never Pay The
| First Bill" by journalist Marshall Allen. I've worked in
| healthcare for 20+ years. I've been on the collecting side of
| many bills, it's a good book for patients. Contrary to popular
| belief most hospital systems are not evil profit seeking
| corpratons but just trying to keep the lights on, it's still a
| business though and as a patient you have the right and
| oppourtunity to negotiate. Most of the time collecting something
| is better than collecting nothing which is more or less the
| default. Of course there are exceptions and abuses.
|
| One other point I think is important, that I see come up a lot
| regarding deductibles, is that your deductible is most likely
| double what you think it is for a lot of situations. Particularly
| emergencies. This is buried in the minutiae of your insurance and
| relates to in and out and network/facility/doctor care having
| seperate deductibles.
| FireBeyond wrote:
| A lot of this has changed with the No Surprises Act, that
| specifically covers Emergency situations and others where a
| patient would be "reasonably expected" to believe that a
| service was in network.
|
| Surprise billing protections apply to most emergency services,
| including those provided in hospital emergency rooms,
| freestanding emergency departments, and urgent care centers
| that are licensed to provide emergency care. The federal law
| also applies to air ambulance transportation (emergency and
| non-emergency), but not ground ambulance.
|
| It also covers non-emergency services provided by out-of-
| network providers at in-network hospitals and other facilities.
| Often, the doctors who work in hospitals don't work for the
| hospital; instead they bill independently and do not
| necessarily participate in the same health plan networks.
|
| Doesn't mean your insurer might not deny coverage or apply a
| deductible that you have to fight.
|
| You also cannot waive certain rights. Like some hospitals will
| try to get you to sign waivers around balance billing, and
| in/out network discrepancies. Some of these will vary by state,
| so be aware.
|
| > The No Surprises Act (NSA) establishes new federal
| protections against surprise medical bills that take effect in
| 2022. Surprise medical bills arise when insured consumers
| inadvertently receive care from out-of-network hospitals,
| doctors, or other providers they did not choose. Peterson-KFF
| and other studies find this happens in about 1 in 5 emergency
| room visits. In addition between 9% and 16% of in-network
| hospitalizations for non-emergency care include surprise bills
| from out-of-network providers (such as anesthesiologists) whom
| the patient did not choose. Surprise medical bills pose
| financial burdens on consumers when health plans deny out-of-
| network claims or apply higher out-of-network cost sharing;
| consumers also face "balance billing" from out-of-network
| providers that have not contracted to accept discounted payment
| rates from the health plan.
|
| Source: https://www.kff.org/health-reform/issue-brief/no-
| surprises-a...
| cvalka wrote:
| This bill is a masterpiece! The arbitration pricing provision
| is a beauty!
| duffpkg wrote:
| To clarify my point, your insurer spells this out to you,
| though you as a patient may not understand it to be the case.
| There is no surprise, its the expected behavior reading the
| literal minutiae of the giant packet your health insurer
| offers you. It's just that many people do not understand they
| have multiple additive deductibles for certain types of care.
| mynameisnoone wrote:
| Except you're tone deaf trivializing systemic evil as a banal
| "business misunderstanding".
|
| I was roadtripping through Redding, CA several years back.
| While in line at a coffee, I ran across a young lady with a
| nasal infusion pump tube taped to her face arranging some
| paperwork. After chatting, she informed me she had Stage IV
| cancer and the hospitals and doctors were coming after her for
| every cent she had while she was dying, and it forced her into
| bankruptcy. The paperwork was for her bankruptcy hearing across
| the way.
|
| This is what happens when for-profit health insurance and
| hospitals are allowed to exist because every other sensible
| advanced economy in the world has universal healthcare. The
| disconnect is American patients don't know how bad they have
| it: their financial liability is essentially unlimited, they
| pay far more, and have worse outcomes.
| beaeglebeached wrote:
| A nasty truth is when people are terminally ill, the vultures
| emerge. With animals too. In socialist paradise your kids
| dispossessed because inheritance is immoral. In capitalist
| paradise, dispossessed because the hospital can charge the
| captive buyer limitlessly. Doesn't matter what system, the
| order of life plays out.
|
| Humans are chimps with high order skills to do the same chimp
| shit and explain it away with various fictions.
| wolverine876 wrote:
| > most hospital systems are not evil profit seeking corpratons
| but just trying to keep the lights on
|
| Why are they struggling so much more now than 10 or 20 years
| ago (when health care costs were already soaring)?
|
| I read about a non-profit childrens hospital in some large US
| city that paid its CEO $7 million.
| rincebrain wrote:
| My favorite was a reason I stopped going to a major famous
| hospital's outpatient clinic in my area, which was that their
| billing department would sell things to a debt collector that
| were paid, and when I called, they'd say you shouldn't be getting
| a notice our system says paid in full, and I'd say "well, then
| why do I have 12 debt collector notices with those IDs".
|
| I suspect they were just opportunistically selling it faster than
| insurance paid them, but the harassment of cleaning that up every
| so often was exhausting (since the hospital would always say
| "well it's not on our end"), combined with a bunch of other shady
| things the place did.
|
| The dumbest part was, they were like, $10 bills, so I can only
| imagine how cheaply they had to have been sold for the debt
| collector to think they could turn a not-loss on it...
| itronitron wrote:
| At some point I hope Americans realize the extent to which they
| are being taken advantage of by the politicians they elect, and
| the companies that lobby them.
| bparsons wrote:
| The concept of "medical debt" is preposterous.
| wolverine876 wrote:
| Don't let yourself get caught up in these details. The problem is
| the unreformed healthcare system; these are just more symptoms of
| it. It's like the old, failing server at work - people say the
| problem is the power supply, the outdated driver, etc. - it's
| not; the problem is we haven't installed a new server.
|
| We all can see the US healthcare system is awful. If you aren't
| doing anything about it, the problem is you. The politicians
| against healthcare reform are well-known; if you can't persuade
| people to vote them out, you're not trying (following the example
| of political leaders who don't try). (And spare me the
| helplessness routine - that's for losers - generations of
| Americans and other democracies have managed to get things done.)
|
| Another thought: It's another institution or market being funded
| by the wealthy (donations) for the wealthy (those who can afford
| it).
| kuczmama wrote:
| > The politicians against healthcare reform are well-known
|
| Who are they specifically?
| verisimi wrote:
| Just vote them out. The medical system is the only issue that
| matters. /s
| paxys wrote:
| One can blame politicians and corporations all they like, but
| the simple fact is that >50% of the country (and significantly
| more than that when accounting for skewed political
| representation) does not want the system to change, because the
| alternative is "socialism".
| giantg2 wrote:
| ... _US government-run_ "socialism".
|
| Because we all know how well they run all the other programs,
| especially if you've dealt with healthcare they already run
| (military and VA).
|
| I'd imagine people would be clamoring for socialized medicine
| if they fixed the VA to be a shining example.
| paxys wrote:
| And yet Medicare has a 94% satisfaction rate.
| edgyquant wrote:
| No it's because socialism isn't the only alternative and half
| the country wants to use it as an excuse to enact socialism.
| antisthenes wrote:
| The absolutely best (and most impactful) thing you can do as an
| individual is to _not pay the damn debt_ to the hospital.
|
| The illusion of impact by writing to your congressman is really
| just that, a proverbial carrot in front of the donkey of
| democracy.
| crazygringo wrote:
| > _If you aren 't doing anything about it, the problem is you._
|
| What do you expect me to do about it? I live in a reliably blue
| area and it's Republicans who are blocking things like a
| single-payer system.
|
| So what exactly are you suggesting? Uproot my life and go move
| to a swing state so I can vote Democrat there?
|
| Because short of that, I don't know what. And the country is so
| culturally divided, it's not like there are many swing voters
| left who can even be convinced anymore. Republicans just don't
| want health care reform, so what are we supposed to do?
| amluto wrote:
| A single-payer system doesn't seem like a magic fix to me at
| all. At best, a single payer _could_ , at least in principle,
| wield enough market power to improve the overall system.
|
| Just look at Medicare. Medicare has enormous market power,
| but it uses that power in more or less absurd ways and does
| not optimize patient outcomes or its own expenditures
| particularly effectively.
| rayiner wrote:
| [delayed]
| massysett wrote:
| The headline doesn't say much and the text doesn't say much more.
| It could be that such debtors are the majority solely because the
| number of uninsured has dropped.
|
| For instance, if in 2000 there were 2000 debtors with 100 of them
| being insured, and in 2020 there are 200 debtors with 150 of them
| being insured, this headline would be true. Which would be ok if
| the story shed light on this, but it doesn't.
| calamari4065 wrote:
| Hospitals love to do this thing where you set up a payment plan
| for auto-draft, but the moment you get a new bill, they cancel
| the payment plan with no notice and happily let your account go
| delinquent.
|
| At that point, I just let it go to collections until the
| collector is willing to settle for a fraction. Or if I get lucky,
| the debt gets sold seventeen times and it just goes away once I
| ask for proof that they own my debt.
|
| Play stupid games, win stupid prizes I say. If you wanna try and
| fuck around with me, I'll do my level best to make sure you lose
| as much money as possible.
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