top | item 19264243

Cancer Complications: Confusing Bills, Maddening Errors And Endless Phone Calls

265 points| thebent | 7 years ago |npr.org | reply

349 comments

order
[+] cletus|7 years ago|reply
In Australia the Leftist government of Gough Whitlam introduced health-coverage-for-all in 1975 with a scheme called Medibank. In 1984 after a couple of governments, Bob Hawke's Leftist government created the Medicare scheme (Medibank became a government provider of private health insurance), which exists to this day.

The most interesting stat I ever heard about Medicare was this: prior to Medicare the number one cause of personal bankruptcy in Australia was medical bills.

So I'm with Bernie on this: health coverage for all is an incredibly important goal.

While we're at it, let's end the monopoly given to drug companies on the sale of pharmaceuticals in the US. You should be able to legally import them from, at the very least, any NAFTA country and any EU member.

[+] tmaly|7 years ago|reply
We still cannot get a price list of medical procedures in the US thanks to the antitrust exemption provided in McCarran-Ferguson Antitrust Act of 1945.

I think repealing this would be a good start. All other industries are required to provide price lists. My friend went to the ER recently for a sprained thumb. They wrapped it in some bandage and he got a bill for $14,000.

His insurance is covering 80% but he is still on the hook for $2800 for a sprained thumb. Something is not right here.

[+] flexie|7 years ago|reply
And that's the essence of this: In the developed world, this is all but a US specific issue. Cancer and other life threatening diseases rarely bankrupt Europeans, Canadians, Australians, Kiwis, Japanese etc.
[+] coredog64|7 years ago|reply
A fair chunk of what we in the US would consider “medical bankruptcy” is not the bills, but a consequence of chronic illness. If I’m living paycheck to paycheck, any disruption is going to hurt. That could be unpaid leave, but it could also be disability insurance that doesn’t replace 100% of your income. Regardless of how health insurance is paid for, those are going to happen.
[+] onetimemanytime|7 years ago|reply
If health care for all reduces prices and total cost, then yeah. Otherwise, the cost will cripple the government, and by extension taxpayers. Right now they can declare bankruptcy and just don't pay (at a great cost, no doubt) but the government will have to pay. Cancer is a fact of life,38.4% will get it in their life https://www.cancer.gov/about-cancer/understanding/statistics and unless costs are dramatically lowered any plan will be bankrupt.
[+] chaosbutters|7 years ago|reply
doesn't matter who is president in 2020, if the senate isn't blue. And right now, it doesn't look like the senate will even hit 50/50.
[+] JamesBarney|7 years ago|reply
I'm all for universal coverage too. But reducing the profits of pharmaceutical companies well reduce the money they have for r&d dramatically.

This will slow down the speed of pharmaceutical development. So I think it needs to be paired with reforms to the FDA to reduce the go to market costs for drugs.

[+] 5trokerac3|7 years ago|reply
The United States currently has the highest 5 year survival rate for all cancers combined. I think it's a fair question to ask if that would continue to be the case in a MFA system for 300 million patients.

Considering what a disaster the insurance marketplace was, I'm very skeptical.

Edit: what I mean by "disaster": when it launched, the site completely crashed for over a month and then, when it finally came back up, the policies offered weren't accepted by most doctors, because they had crazy restrictions.

[+] mnm1|7 years ago|reply
This is the only solution. Every other developed country in the world has healthcare for its people. Politicians that don't support this are monsters who'd rather kill millions and ruin millions' more lives. They are disgusting, inhuman, immoral scum who would rather enrich their billionaire backers than help people live and recover from illness. These are the people that we should use the death penalty on because they have killed and will kill millions unnecessary. All out of greed and hate for their fellow Americans.
[+] zawerf|7 years ago|reply
I think that's just a corollary of "63% Of Americans Don't Have Enough Savings To Cover A $500 Emergency":

https://www.forbes.com/sites/maggiemcgrath/2016/01/06/63-of-...

EDIT: My comment is in reference to the old thread title, which was something like "More than 42 percent of the 9.5 million people diagnosed with cancer from 2000 to 2012 drained their life's assets within two years"

[+] vamos_davai|7 years ago|reply
It's such an absurd expense that I wonder if I get diagnosed with cancer, I would just deny treatment, accept death, and hand my assets to loved ones. Not sure if anyone else thinks the same way.
[+] grecy|7 years ago|reply
It always seems any American that is against Universal Healthcare quickly changes their tune as soon as they or their loved ones are hit with bankruptingly large bills for things they have no control over.

What a shame they can't see outsides themselves and realize they're only an inch away from financial ruin.

[+] davidscolgan|7 years ago|reply
This is honestly one of the things that most stresses me out as I get older. I don't use my insurance much now because I'm pretty healthy, but I know my cancer risk will just go up over time.

I've considered that if something like this ever did happen, I'd move to Lithuania and do it there paying in cash over trying to do it in the US system. Universal health care can't come fast enough.

[+] creaghpatr|7 years ago|reply
When you get old you presumably qualify for Medicare.
[+] maerF0x0|7 years ago|reply
> Universal health care can't come fast enough.

What do you mean by "Universal healthcare"?

[+] shereadsthenews|7 years ago|reply
I'd like to know where the patient with the $870 MRI bill was seen. My last MRI was billed at over $7500. Before I started treatment for my brain tumor I got divorced for purely financial reasons and gave all my remaining money to my children. USA is so fucked.
[+] nradov|7 years ago|reply
For non-emergency imaging studies it's worth shopping around. Prices really can vary by a factor of 10× between facilities in the same area. For those with private insurance, most major insurance companies offer some sort of cost estimator on their web sites which allow members to see which radiology centers are cheaper.

(I do appreciate that this is a bad experience for patients.)

[+] madengr|7 years ago|reply
Other than cash, how do you give money over $15k without being nailed by the gift tax? Keeping as much money in retirement savings seems wise as those are exempt from liens.
[+] 01100011|7 years ago|reply
Some of the cost difference is likely due to different procedures and materials(i.e. contrast agents).
[+] Marsymars|7 years ago|reply
We've got private MRI clinics in Canada, and Googling prices for my city gives a number of clinics with prices in the 700 CAD range.
[+] cabaalis|7 years ago|reply
57% of Americans cant handle a surprise bill of $500 without going into debt. [1]

I don't doubt cancer is probably the most expensive hit that we have a good chance of receiving, but I'd be inclined to point to the lack of "life's assets" being fluid as the first problem to tackle.

[1] https://www.cbsnews.com/news/most-americans-cant-afford-a-50...

[+] BucketSort|7 years ago|reply
It's amazing that you got down voted so much. Do people not like facing reality or something?
[+] Sahhaese|7 years ago|reply
Well I can't speak for all countries, but here in the UK I haven't paid a penny toward my cancer treatments.

I also kept my job despite being off work for nearly a year going through chemo, and I even got sick pay for all of that time. (Not at full wage, but still a very generous proportion of it).

Post-treatment I went back to my same workplace, doing the same job, and found out that I had even acrued annual leave at full rate during the 9 months I was off sick, so had 25 "extra" vacation days that I wasn't expecting.

Yes, this is more than the legal baseline, but even the legal baseline would let me keep my job, acrue leave, get some sick pay (although the statuatory sick pay isn't huge), but most importantly, have completely free treatment, so I wasn't spending the little energy I had worrying about medical bills or insurance.

[+] erichurkman|7 years ago|reply
I wonder what the downstream effects of this are on building generational wealth. 100 years ago, when your parents died, you might inherit a home or a small amount of money. That then helped uplift the next generation. Now, if your assets are drained, you have a reverse mortgage, etc, there's nothing to pass on except for the very wealthy.

Cancer sucks.

[+] DanCarvajal|7 years ago|reply
This was definitely the case with my grandparents, but it wasn't even cancer it was just the long term cost of care for people who live well into their 90s.
[+] duxup|7 years ago|reply
>Cancer Complications: Confusing Bills, Maddening Errors And Endless Phone Calls

Hell that's just insurance in America... if you just use it.

I've been dealing with a bill where the insurance company decided that my kid's pediatrician was out of network all of a sudden. All the other visits to the same pediatrician have been covered, but they can't seem to fix this one bill....

There's no incentive for the company to be helpful as what am I going to do? Change insurance companies? That's not my choice.

[+] OnACoffeeBreak|7 years ago|reply
This is a 2019 article covering a study that covers 2000 to 2012 and doesn't mention the Affordable Care Act signed into law in 2010. Insurance landscape has changed quite a bit in the USA since ACA, which makes this not very interesting. What I would be interested in is repeating the study now and comparing results.
[+] corbet|7 years ago|reply
I would expect the results to be no different - the article was talking about people who already have insurance. I've been through the incredible medical-bill maze that results from cancer treatment since then; it's just the same. The ACA was explicitly designed to perpetuate the current insurance system, why would you expect the situation to have improved?
[+] cannonedhamster|7 years ago|reply
I got cancer in 2018. Very little has changed. It's still very expensive.
[+] rayiner|7 years ago|reply
This came up last year when it was discovered that Leon Lederman had to sell his Nobel Prize to pay for cancer treatments. But there is more moral complexity to this issue than people appreciate. Cancer treatment is inherently expensive; it just doesn't seem that way in some other countries because the government pays from the outset.

But I don't think that's necessarily moral, compared to something like Medicaid, which requires people to spend down their assets first before the government will pay. The median net worth for someone between 65-74 is $225,000. Why should the government spend tax dollars to protect those savings for people unfortunate enough to get cancer, when there are many people unfortunate enough to never enter the middle class and be in a position to save that kind of money in the first place? Isn't it unfair to spend tax dollars protecting the inheritance of an upper-middle-class kid when that money could be given to a kid that never had a hope of an inheritance?

Put differently, there is a huge moral difference between the government ensuring that everyone can get cancer treatment, and the government intervening to protect the financial and social status of people fortunate enough to have significant assets.

[+] rconti|7 years ago|reply
I cannot even imagine the toll this would take.

I have a very simple set of recurring claims against my healthcare provider that I'm handling myself (out of network, no problem, I thought). Due to job changes I had successfully had my charges reimbursed by my previous 2 insurance companies over the past year.

The current one has taken 6 months to finally start reimbursing me -- and actually, they're almost caught up! Every goddamned time, the helpful phone persons sees the problem: "Your provider was entered as an XYZ type of provider instead of a ZYX provider, so it was being sent to the wrong unit. I'll re-enter him correctly, delete the old entry, and resubmit your claims marked as urgent. They should be processed within 7-10 days..." Very helpful staff. They seem to get it. They seem to figure it out. They seem to fix it. And it's never. fucking. fixed. And so you wait 7 days. You want 10 days. Still in process (if the horrible online system even allows you to login today). You wait 14 days, thinking maybe that was 10 BUSINESS days. Then you call back. Again, and it's the same thing. Over and over again.

My reimbursements came totally out of sequence. The claim numbers don't match. The dates on the claim number don't match the dates on the EOB, they're paying me back for the wrong visits!

But somehow, somewhere, on the backend, someone is reconciling it. Amazingly, the amounts are adding up. I think the processors are REALLY GOOD at not accidentally double-paying, so even though they're paying me for the wrong dates here, the next time they avoid double-paying, and find ANOTHER date to pay for (properly). It actually looks like it'll somehow all get paid back. Again, all one insurance company and one health care provider. And it's my insurance. And it's top tier private tech company employer PPO type stuff.

My wife was in the hospital after a car crash. The first EOB I got for $200,000 saying "Denied", and that number didn't even include the surgery. I just laughed. It went to the wrong insurance, a simple call and it was sorted.

But I can't fathom having less than perfect insurance (and I don't even know how to manage to maintain good insurance while having cancer and potentially being out of work and having a partner who might not be able to work while they're helping you), and having millions of dollars in bills, and having them come in from countless different providers.. sheer misery.

[+] h3daz|7 years ago|reply
Moving to Switzerland, you'll be compelled by law to get health insurance and you will be covered no matter what for roughly 500 bucks a month with a 300$ deductible.
[+] triplewipeass|7 years ago|reply
When I was in my early 20s, I got myself a beefy life insurance policy that covers suicide after some waiting period that has expired many years ago. I know that in case of crippling illness I can always take the easy way out while preserving my assets plus the life insurance payout. My family would be taken care of.
[+] komali2|7 years ago|reply
>My family would be taken care of.

And possibly traumatized that you killed yourself so they could have money.

[+] smallgovt|7 years ago|reply
It's interesting to me that life insurance policies exist that cover suicide. I assume it means that people over-estimate their eventual willingness to commit suicide.
[+] bluetidepro|7 years ago|reply
I didn't know this was a thing (life insurance policy that covers suicide), very interesting.
[+] 01100011|7 years ago|reply
It's not just the billing that sucks. It's also the care, or lack thereof, in the health care system.

I remember taking my friend to a Dr. visit when he had a brain tumor. The parking was confusing, with signs threatening fines of hundreds of dollars for parking anywhere near the building(this was at UCSD in La Jolla). This was at a cancer center, where you'd expect they'd prioritize access for patients. He went in for an eye exam, and the doctor was getting extremely agitated because my friend had problems communicating and performing a few tasks as quickly as the doctor wanted. Very few people in the hospitals seemed equipped to handle someone who had problems seeing, walking and communicating.

[+] deisner|7 years ago|reply
"But none of these is her most gnawing, ever present concern.

That would be the convoluted medical bills that fill multiple binders, depleted savings accounts that destroy early retirement plans and so, so many phone calls with insurers and medical providers."

Is it like this in other OECD countries? I ask because I'm told that we in America have "the best health care system in the world."

[+] gambiting|7 years ago|reply
My father fought cancer for the last 8 years of his life, and was on 2 boxes of Glivec a month for all those years(in US Glivec treatment costs about $146,000/year[0]). He also had 2 operations to remove some tumors, plus bi-monthly MRI to check if the cancer came back. He has never paid a single penny towards the treatment. In fact, the hospital would always reimburse him for taking the train every month to get his drugs and check-ups done. There were no bills to pay, I think he only had to sign one piece of paper every month to say that he picked up his medicine and we could go home. There were never any calls to any insurers or medical providers, simply because as patient over here you don't care who is paying for the treatment. You turn up to the hospital for whatever treatment is planned and that's about it. You don't even know how much the hospital is paying and to whom. It doesn't even matter if you are currently employed/unemployed and if you're paying towards the national health service - if you are not employed(say as a result of your illness) you are still 100% covered anyway.

After he passed away(the cancer unfortunately came back and not much could have been done at that point) his savings account was definitely not affected by 8 years of illness.

That's in Poland btw.

[0] http://www.ascopost.com/issues/may-25-2016/the-arrival-of-ge...

[+] mikestew|7 years ago|reply
I ask because I'm told that we in America have "the best health care system in the world."

I'm going to assume that you're asking an honest question, but I'll tell ya that (and I can not emphasize this enough) from my perspective the question is so naive that I seriously think I'm missing the sarcasm.

But in good faith I shall carry on...AFAICT, "US=='best'" is propaganda, or ignorance at best. We (I am an American) have poorer outcomes for more money spent. Now, many excuses will be offered as to why that is, but I'm not here to argue; as best as my research can do, that appears to be fact. On top of that, for a less capable and more expensive product, we have a byzantine system of forms and providers.

So, no, it would appear that other OECD countries do not have this issue, partly/mainly because all but a few (and I would be hard-pressed to name those few) socialize their medical care.

[+] lotsofpulp|7 years ago|reply
No, my family in Canada and UK don't deal with any of this. In the US, it's not even worth your time figuring out how much your treatment will cost, other than whether or not the provider is in network or not. Assume it's the out of pocket maximum for your insurance, because when you go to a provider, you sign a blank check that says you will be responsible for whatever chargers they make up during the course of your treatment. So your only ally is the insurance company, who has the power to deny payment for things like $15 worth of linens (which was actually a few pieces of paper towel).
[+] lars512|7 years ago|reply
No, this side of it is definitely better in other countries.

My late wife passed away of cancer a few years ago, we lived in Australia. She went through rounds of intensive treatment. We had private health insurance which kicked in, limiting our up-front costs. Not all was covered, but what wasn't covered was capped through public health care. It might have cost us $10k AUD, but not more.

We spent little to no time worrying about paperwork and billing, it was almost all auto-handled for us.

[+] Xixi|7 years ago|reply
The administrative/insurance side of American healthcare is probably one of the worst, if not the worst in the developed world. But the quality of the care itself (the actual treatments) is very high, probably one of the very best. I think the American health care is especially good in terms of treatment availability: many drugs are simply not available in other countries (or are available but not covered).

Some people are genuinely concerned than touching the former (administrative side) will result in lowering the level of the latter (quality/availability of care, drugs, etc.). That it's the inherent high cost of the current US system that somehow makes it so good in terms of availability/quality of care. I disagree, but can somehow understand the line of thought.

EDIT: I have no idea to what extent care is really better in the US than elsewhere, but know first hand of someone who had to pay for interferon out of pocket in Japan because it was not yet covered at that time. It's not rare for the newest US drugs to take many years to cross the Pacific ocean...

[+] Sharlin|7 years ago|reply
No, it is definitely not. Whoever tells you that is either lying, ignorant, or in denial.
[+] whack|7 years ago|reply
> "Their high-deductible insurance policy meant they had to spend $6,000 before their insurance started covering her treatment expenses. They hit their annual out-of-pocket maximum of $10,000 well before the year was over."

The article mentions a variety of causes but I'm having a hard time figuring out which ones are most important. In the example above with a $10k out-of-pocket maximum, how much money did these patients actually end up paying? Is that the main reason for their bankruptcy, or is it their loss of income? Does disability insurance cover things like cancer, and if not, are there similar programs that do?

[+] kevmo|7 years ago|reply
I published a piece on debt in America last week and touched in the subject of medical debt. When you look at it from a broader perspective, most Americans are in a financially dire situation. 42% sounds lower than I would have expected.

Americans are Drowning in Debt: https://thenib.com/americans-are-drowning-in-debt

[+] pastor_elm|7 years ago|reply
I remember the radiolab episode on worth[0]. Is another month of life with cancer worth x amount of dollars? Who should pay 100k for a medication that might let you live a month longer with pancreatic cancer. I imagine most Americans don't look at it that way.

[0]https://www.wnycstudios.org/story/worth