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ydt | 8 years ago

I had this same thing happen. My daughter was admitted via ER and it turned into a 6 day stay. At the end we received a bill for 40k for being out of network. Luckily I have friends in the industry and it turns out if they fail to inform you within 48 hours that you're not in network you don't have to pay the out of network cost. We ended up paying just our deductible after a letter was drafted. Do not take what the hospital/insurance Co say at face value. Call an attorney.

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eatbitseveryday|8 years ago

> Luckily I have friends in the industry and it turns out if they fail to inform you within 48 hours that you're not in network you don't have to pay the out of network cost.

Curious, can you perhaps provide evidence of this? Seems like a good thing to know.

> Call an attorney.

This is itself a cost, and maybe only makes sense if you owe ≥ $10k but for procedures billed as $1k when they should be $400 I don't think warrants the cost and time of an attorney; what other recourse is there except to pay?

dragonwriter|8 years ago

Many attorneys will provide a free or very low cost initial consultation; you may have an unrealistic picture of what the actual cost of legal services for this particular scenario would be, and may benefit from actually finding out before assuming they are too expensive.

ydt|8 years ago

I have no evidence other than a person that works in claims for an insurance company looked at my claim, drafted a letter citing relevant statutes and the bill went away.

I agree that an attorney only makes sense if you're facing a significant bill. On a smaller bill I would go to the hospital billing department and negotiate.

dungle6|8 years ago

If you have excellent credit you can simply not pay and make them do the work. I had a $1500 dispute. I was getting tired of wasting time. When it went to collections I drafted the standard leave me alone. The funny thing is now the collection company has screwed up twice on some things. It is their prerogative to sue. I doubt they will. If they do it, it will be annoying but I can respond in kind with a countersuit. Oh and the credit score? Dropped about 40 points into the upper 700s. Annoying, but not worth just rolling over and paying.

You can of course negotiate as well.

moheeb|8 years ago

I agree with dungle6, whose comment is now dead. I say screw them and don't pay. Ignore collections for a few years and don't be a wuss about your credit score. Problem solved.

patrickg_zill|8 years ago

A consultation with the lawyer will be free or low cost. Paying even 200 to save 600 seems like a good idea.

pmorici|8 years ago

The 'Surprise Medical Billing' protections seem to vary from state to state so you really need to do the research for your particular location.

mistermann|8 years ago

Can someone knowledgeable on the subject comment on whether the "Obamacare movement" has been up front in acknowledging this aspect of the problem with health care in the US?

My perception is that the problem is typically framed as a lack of insurance problem for financially challenged people, but the "abuse" on the billing side to me seems like at least as big of a problem. And if this is being conveniently ignored, it feeds my conspiracy thinking that the Democrats are actually largely indistinguishable from Republicans - they may wear a different mask, but their actions are only slightly different, in this case altering who is getting robbed.

tptacek|8 years ago

The fact that the problems addressed by the Democratic health care bill are orthogonal to some other problem you care deeply about is not, logically, evidence that the Republicans and Democrats are "indistinguishable" when it comes to health care. The status quo ante of the ACA was a system in which millions of people were locked out of insurance by fiat due to pre-existing condition bans. For those people, all providers were "out-of-network".

Mz|8 years ago

The problem isn't abuse on the billing side per se. The problem is that insurance is about risk management. In laymen's terms, it amounts to taking a bet. When you insist that private insurers cover people with pre-existing, incurable, chronic conditions, there is no "bet" to take there. It is all downside for the insurer. It amounts to charity. This fact then seriously distorts the business model, driving up costs for everyone in a big way. It has to be covered somehow.

We need a single payer system because, at the societal level, it makes sense for government to make sure people get their healthcare needs met for the same reason it makes sense for government to provide police and fire protection. But forcing all Americans to get private health insurance makes no sense and indicates a fundamental misunderstanding of what the insurance industry does.

Direct Primary Care, single payer and wellness programs all have a good track record of genuinely getting people healthier while bringing down costs. Obamacare cannot do any of those things and just runs expenses up.

Source/qualifications: Among other things, I worked in insurance for over five years. I have a certificate from a technical college in life and health insurance, paid for by my former employer.

cookiecaper|8 years ago

The insurance model is at the heart of the medical system's issues; it distorts the market by disconnecting prices from providers and consumers and severely disaligns their interests.

The provider must set a high sticker price so that they can give the insurer the expected 60-80% discount to get in-network (and still tolerate underpayment and other shenanigans). The consumer is either intentionally misled or confused (usually both) about basically everything cost-related, and often won't learn the true out-of-pocket cost of a service until ~1 year after receiving it, when the billing process has (mostly) finished.

Example: just yesterday I got a new bill for a routine lab test I received in December. It says that the insurance discount applied, but they never sent a payment, and thus I owe a balance of over $200 to the lab company. Now I have to call the insurer to figure out why they denied payment, which is sometimes due to an administrative error, sometimes a paperwork thing like signing a document that verifies there is no other possible insurance carrier whom may have been responsible for the bill, etc.

Obamacare is thus anything but up front, because honestly working to fix the American medical system would involve excising market-breaking, paper-pushing leeches from the marketplace, but Obamacare props up this destructive apparatus by forcing every American to pay in or get fined.

chasing|8 years ago

> it feeds my conspiracy thinking that the Democrats are actually largely indistinguishable from Republicans

Have you been watching anything that's been happening with the healthcare debate over the past, oh, 25 years? The Democrats have been trying with varying degrees of success to inch this country in the direction of a more sensible healthcare system and the Republicans have pitched a generation-long hissy fit about it.

heartbreak|8 years ago

Well the progressives including President Obama pushed for single payer (or a public option) which would eliminate abuse on the billing side, at least to the insured.

dboreham|8 years ago

Yes there were attempts made in the ACA to control costs (hence the first 'A'). However 1. the clock ran out on the bill drafting due to people voting for republicans in mid-terms and 2. Corruption.

maxsilver|8 years ago

> My perception is that the problem is typically framed as a lack of insurance problem for financially challenged people, but the "abuse" on the billing side to me seems like at least as big of a problem.

If anything, the billing abuse is a much, much larger problem than lack of insurance. At least, that has generally been true since the ACA/"Obamacare" changes passed.

seppin|8 years ago

> Do not take what the hospital/insurance Co say at face value. Call an attorney.

What a terrible industry.

stronglikedan|8 years ago

That applies to any and all insurance - especially mandated insurance policies. The main job of the insurance company is to collect your premiums and the find any way to deny your claims.