[nthompson]

Buddy of mine breaks his collarbone, gets some pins put in. They drop him a bill for $25k.

He says "I'll give you $1500 now, or you can send me to collections."

They took it; now I use this technique all the time.

They make up a number which is how much they hope to get out of you, and you should return the favor by make up another number. Then scream at each other on the phone for a few hours before coming to terms.

Sad that it's come to this, but medical billing is a shell game. You can play it too.

[will_brown]

>They took it; now I use this technique all the time.

I’ve done this once for a $12,000 bill for a few stitches. They refused any deals, until I showed I actually took video of hospital staff promising it wouldn’t be more than $2,000 before treatment, in response they waived the entire bill.

The way you phrase this though...how often are you receiving acute medical treatment?

[webdevmark]

As a British person living in the UK reading stories like this seems so crazy. The very idea that when Americans are ill they need to negotiate with these huge institutions seems so utterly bizarre and messed up.

Surely if people know they could be fined thousands for simple treatments like stitches they avoid medical care altogether? Then things could get worse and even more expensive...

[hombre_fatal]

I live in Mexico and have had to get stitches many times. Paid $4 per stitch in the private hospitals in Guadalajara. I paid $24 in cash with the pesos in my pocket and walked home.

Even the dentist system in Mexico is walk in, pay, walk out for high quality work. I tried to go to the dentist when visiting family in Texas and had to fill out paperwork and pay to be a member first.

Seems like the only benefit of the US system is when you have a nice job, everything is basically free. Probably why nothing will change too much anytime soon. To quit your nice job to try to start a business forces you to gamble with your healthcare.

[caprese]

I should do that

Everytime some staff member says "it will be covered we are just doing x, y, z this is covered"

and then you get a bill from the insurance company and the doctor's office says "we THOUGHT it was covered"

[jopsen]

> The way you phrase this though...how often are you receiving acute medical treatment?

I was unable to a price quote of any kind before elective procedures, when I lived in the US (last year).

My insurance was good, but they would not say if they would cover the bill ahead of time.

[jaunkst]

Yikes. Think I'm going to learn to do my own stiches.

[tombert]

About ten years ago, my wife had to get her gallbladder removed; they had a bill of $75,000. Her family was very poor, didn't have insurance, and they similarly made an ultimatum of "you can either get nothing from us, or you can get $5000", which the hospital accepted. $5000 was of course still a struggle, but how absurd is it that they were effectively doing a 1500% markup for a life-saving procedure?

If they hadn't known about this trick, there's a good chance that her family would have had to declare bankruptcy to pay for this, which of course means that the taxpayers are stuck footing the full bill.

[mixmastamyk]

Well, they took some amount that covered their costs. It's not clear they made a profit or not. They know some will not pay and pass the cost onto the rest of us.

[dugluak]

We were charged $9000 for epidural during our first child's delivery. After a lot of back and forth between me, the hospital and the insurance company I ended up paying $99. I never tried to understand the logic.

[empath75]

I had two insurance companies when our first kid was born, and the hospital completely botched the filing leading to both companies denying the claims because of late filing and so on (we gave them additional the info they needed a few days after the initial claim was denied — they didn’t refile until nearly a year later).

They tried to come after us for 10s of thousands of dollars in bills.

After much back and forth with insurance companies and the hospital most of it was either discharged or paid for by insurance, they eventually sent us to collections for $1000.

Unfortunately for them, I had been taking detailed notes of conversations, including people I talked to and dates and times, and had gone through itemized bills, noting things like duplicate charges, and multiple times I had been lied to on the phone by the billing department about what paperwork they had filed with the insurance companies and when along with documentary evidence by the insurance companies.

By my reckoning they actually owed me an $800 refund from a check I had sent them earlier to cover a charge that an insurance company later paid.

I said if there isn’t a check in the mail today for $800 and the collections notice retracted, I’m taking all this information and filing in small claims court.

It was taken care of that day.

My kid was already walking by the time the billing was handled for his birth.

It’s so depressing because as a hospital, we have absolutely no complaints about the care. It’s hard to believe that they can be so competent at delivering care and so completely incompetent at billing for it.

[snarf21]

The logic is that anyone who does pay makes them a ton of money.

[maxxxxx]

In what way are these guys different from mob guys running a protection racket? They seem to operate exactly like thugs that come to a restaurant, ask for money for "protection" and then often walk away with 10% or less of what they asked for.

[fma]

If mob guys lobby politicians to make their protection racket legal, then no difference.

[Broken_Hippo]

This seriously can backfire, though. The hospitals where I lived... they took folks to collections. They would take you to court for a fairly low amount of money and garnish your wages. Sure, it takes longer, but they'll get their money. IIRC, in the state I lived in, they can take 25% of your pay as long as they leave you an amount equal to 30 hours at minimum wage.

It generally just takes years longer.

[Buttons840]

How can you avoid the "backfire" of having to pay the whole bill? Just pay the whole bill straight away?

People should be honest and pay reasonable bills. But forcing collections and/or lawsuits is one way to put on display for everyone how bad our medical care charges can be.

[cosmie]

When using the technique, be sure to get confirmation in writing that the bill is paid in full.

I've used it twice before. Once the hospital offered to consider it paid in full if I paid my entire $500 copay at time of discharged (i.e. anything left after copay + insurance payment would be written off).

The second time, I was able to get a facility fee negotiated down from $5k to $1k. The $4k difference found it's way to debt collections and onto my credit report due to the way the payment was written down in the system, and it was hell getting it dealt with since I didn't have explicit confirmation that the $1k wasn't a partial payment on the full bill.

[jokoon]

Won't the healthcare market fail at some point if this keeps going on? I mean there might be some big loan somewhere that will default one day. No idea what will happen then.

[kemiller2002]

There is a whole lot of accounting magic, and forecasting that goes on. They know that they won't get a lot of it, but there are several things they do to "mitigate" their "loss". They get to write it off on their taxes. They'll often sell unpaid debts to 3rd party debt buyers. They'll get some money out of bankruptcy etc.

[cbm-vic-20]

That depends on how much it actually costs to deliver their services, in aggregate.

[barry-cotter]

What market? If you get problems from regulation and the solution is always more regulation you eventually get a Rube Goldberg state run health system. If the US wanted cheaper medical care they could disaggregate medical care and actually try to drive down costs. As it is the supply of people who want to be doctors just keeps going up and there are plenty of foreign doctors who would be delighted to work in the US who aren’t allowed to do so. The AMA doesn’t want nurse practitioners and it doesn’t want foreign doctors and they’re winning. Hell, look at India, they have something close to a free market in medical care and factory line hospitals where people get better at the procedures they do by doing one thing many times and list prices. Why can’t the US do that?

https://www.chrisstucchio.com/blog/2015/medical_tourism.html

> One of the things I like most about India is it's medical system. As an American, I've experienced both the Indian and US medical systems, and at this point I have a very strong preference for the Indian one. Somewhat surprisingly, the Indian medical system is based on free market capitalism, and as a result it tends to provide a much better experience than the US system.

[dekhn]

Thank you for pointing this out. I really hate articles that treat the rack rates presented to uninsured consumers as a fixed bill; it's not. I think this is something where articles could do a better job of explaining to readers how the rates are really an opening to negotiation (the negotiations already done by insurers).

[vlunkr]

The problem is that it’s not presented as a negotiation to consumers. Negotiation/bartering are far from the norm in our culture.

[microcolonel]

> Sad that it's come to this, but medical billing is a shell game. You can play it to.

All irregular billing is a shell game.

[ticmasta]

Do most hospitals run billing systems supplied by Oracle? That would explain this "size-'em up" pricing strategy...

[YeahSureWhyNot]

they will probably still send him to collections, just later. thats what happened to my friend who needed surgery on his hand.

[nthompson]

Yeah, but medical bill collections has way less weight on your credit than (say) a car bill past due.

They send so many people to collections that even creditors don't care about it anymore.