That it takes such effort to pass a bill like this - 80% public approval, banning a clearly predatory practice, has turned me from a pure free market thinking into a believer in single payer healthcare. The free market just doesn't work when there is very little elasticity in consumption. I've been on the receiving end of a $15K air ambulance bill (thankfully covered by insurance) as well as the out of network specialist at an in-network hospital. The latter is particularly galling. What are you supposed to do, interrogate every person that comes in the room?
> Surprise bills happen when an out-of-network provider is unexpectedly involved in a patient’s care. Patients go to a hospital that accepts their insurance, for example, but get treated there by an emergency room physician who doesn’t. Such doctors often bill those patients for large fees, far higher than what health plans typically pay.
How do courts uphold this? You go to a restaurant, they say you can buy the tasting menu for $100, but they have a temp chef working that day which will cost you $50 extra, which you find out as you're paying.
I mean you might even be unconscious when this is happening?
EDIT
Actually someone brought up an important point. If you go to a restaurant, you are kinda expected to know that there's taxes and tipping to pay. Do the US courts think the same of healthcare? "You were in a hospital, you should have known that the bill is always higher than the sticker price?"
The courts can only act where there is law. It's a legal system, not an inherent fairness system -- current law upholds the status quo, which is why this measure passing is good news.
"How do courts uphold this? You go to a restaurant, they say you can buy the tasting menu for $100, but they have a temp chef working that day which will cost you $50 extra, which you find out as you're paying.
"
In the US you go to a hospital and basically sign a contract "you can charge me for whatever you feel like". What surprises me is that they get away with often charging for stuff that never happened. When you confront them they just say "Oops!" ad take it off only to try it again next time. I don't understand how they get away with that.
> Some private-equity firms have turned this kind of billing into a robust business model, buying emergency room doctor groups and moving the providers out of network so they could bill larger fees.
If this doesn’t describe evil, I don’t know what else would.
It's hard to see how anyone could extol the virtues of a "free market system" where behavior like this exists. It is pervasive in American health care. Just search for "orphan drugs" if you are insufficiently outraged. [1]
Agreed. I read that this morning before seeing it on HN - and this sentence stuck out to me. These are the people who should be on the receiving end of a revolution.
I wouldn't reject this out of hand, but I do find that the complexities around healthcare and the obvious political implications lead to a lot of exaggeration and outright falsehoods being propagated.
it's my understanding that the affordable care act requires insurers to treat any emergency services (if covered at all) as in-network. can anyone explain either a.) how I am wrong, or b.) how this can be circumvented?
I was working on a health insurance related startup for awhile so I would say I know more than the average person about the space, and even I get surprised on a regular basis by the absurdity in this field.
For example, I was finishing up an advanced degree program between September and January and my University decided to terminate my health insurance in September. Without telling me. In the middle of a pandemic. When I discovered this last week, I attempted to buy health insurance directly from insurers and was informed that I could not get coverage until January 1st of 2021 as I was "outside the eligibility window". They literally won't sell active coverage to me at any price. Apparently you only have two months after losing your insurance to be able to buy new insurance before having to wait until specific times in the year. I can buy home insurance, liability insurance, car insurance, and any other type of insurance whenever I want but god forbid I try to buy health insurance 61 days after an arbitrary point in the year. I effectively cannot go outside until January 1st as if I get covid and have to go to the hospital I'm screwed.
Just as a heads up in case you or anyone else reading this is in this position. For the uninsured, if your treatment is directly related to Covid-19, you would be covered under the Covid-19 HRSA program described here. https://www.hrsa.gov/CovidUninsuredClaim
You can buy short term insurance. It is outside of the healthcare market place and typically does no cover pre-existing conditions (you have to qualify for it). I actually switched to it 100% as the premiums are way cheaper and I just want insurance against million dollar fees on the low chance I get cancer or I'm in an accident.
I had to provide a urine sample to get my ADHD medication. It was sold to me under the auspices of drug testing, even though ADHD meds are out of your system in 48h. A month later I received an explanation of benefits from my insurance company that said they received a 14k bill and had paid 4k of it, so I was on the hook for the other 10k. Furious I went to my psych. They casually said “we’ve taken care of it, you shouldn’t receive an actual bill”. Uh, that’s not the point? The point is why was it necessary to send my urine for 14k in testing in the first place? You cannot convince me they weren’t getting kickbacks from this program. Finding a new psych is difficult, so the next time they asked me to pee in a cup I asked if they’d charge my insurance the same way again. I haven’t been asked for a urine sample since, which is odd considering they have signs clearly posted saying drug tests are mandatory. I guess not _that_ mandatory, huh?
It’s wild that individuals are forced to navigate this system, much less fight it when they’re being fucked. The idea that there are people who’s sole purpose is designing beurocratic gears to grind money out of sick people makes me sick. And they employ an army of low wage call center folks to do their bidding, work that I can’t imagine is super rewarding. How much better would the world be if we tore down these machines and paid all of those people to do literally anything else?
The change does not apply to ambulances (except for air ambulances), ensuring the United States remains one of the few places in the world where a seriously ill person needs to debate if they're willing to risk their health and life to avoid a financially crippling trip to the hospital.
Ambulance companies are flat-out extortionists and they should be charged as such. We've received bills that say in large print "Your insurance will not cover this", then when I call my provider says "Of course we cover it, send us the bill"
While the bill is working it's way though insurance we'll get new bills, every week or so, "We have not received payment and this account will be sent to a collection agency." Call the ambulance company and they say "oh nevermind, it's marked pending".
It's a scam. They want to scare you. They want to scare you out of getting a negotiated insurance rate. They want to scare you into paying before the insurance comes though. They want you to have to call them and fight to get your money back after insurance pays
After my 2nd motorcycle accident, I refused the ambulance to the hospital to be checked out, because I was more afraid of 4 figure ambulance bills than I was of long term effects to my health
When our youngest was born the nurses (incorrectly) thought his blood sugar was low and had him transferred to a different hospital via ambulance. We were able to fight and get the $2000 bill waived on account of the fact that it was a needless trip. Unfortunately my wife spent the night alone as I was with our son.
On a somewhat related note in the span of 10 years the cost to us to deliver our kids doubled. Same hospital too.
This can be regulated at the state and local level; current state solutions had no ability to regulate air transit fees.
However even local
government is getting in on this revenue stream. The last ambulance bill I saw (for a relative) was from the city’s fire department, which is already funded by (fairly high) property taxes.
As an immigrant coming to America, honestly the most shocking and surprising thing (apart from the state of homeless in San Francisco being tolerated as normal) is the medical care expenses. How on Earth is it that I can walk into a doctor's office or hospital to get medical treatment and have no idea how much it's going to cost? $10? $100? $1000? Who knows. I had an ear infection once, went to the doctor who looked at it for a minute and said "give it a few days". I assumed this would cost maybe $20 or something? Nope. $400. There's just no way of even knowing. In no other industry would you buy something without knowing the price ahead of time. With medical care it's even more screwed up because, well, it's your health? You're generally more desperate for services now, so it's not like shopping around for clothes or something.
It's pretty tragic that there are so many people like you and me, immigrants who have experienced several different healthcare systems, and we can all testify that the US system sucks on every level compared to other systems.
And yet, there's a huge amount of Americans who have only ever lived in the US, who are certain the US system is the best in the world, and who believe all the scary stories that are designed to make you think so.
You could listen to the people who have actual real-world experience, or you can listen to the lobbyists who are paid to preserve the lucrative US system. How is this even a thing?
The current US medical system reminds me a lot of very important legacy code that's become unmaintainable. Maybe the best way of rolling out universal healthcare is to take a refactoring approach. Get more and more people onto medicare, lowering the age limit and raising the maximum income threshold. Eventually, it would only be the wealthy who were still on the private insurance only system. Then employers can gradually replace health coverage with other benefits.
My state (Oregon) has protection against this. Unfortunately my emergency spinal operation was 2 months prior to the bill going into effect, so I got hit by this.
The part that pissed me off was I KNEW about the practice and specifically made a fuss about making sure everyone in that OR was IN NETWORK. I went to an in network facility, my surgeon was in network, and so was the anesthesiologist and every person that entered my hospital room I asked if the OR staff was in network (the answer was always yes). 1 month later I get a bill for a neuro-monitoring team and an assistant-surgeon that were both out of network.
The assistant surgeon charged me about $500. The neuro-monitoring team sent a ~$20,000 bill with the promise that they'd lower it to a reasonable value when I called to pay. Furthermore Blue Cross sent me a letter saying it wasn't pre-approved (even though the procedure was) and they would not cover a cent of it. Imagine the feeling of doom wondering just how low could these shysters possibly go from 20k. Thankfully that turned out to be true, the final bill was $800. Which still made me furious because I made such a huge deal out of not getting into this situation.
So that was $1300 total out of pocket that I was not expecting to pay. Luckily I'm a software developer with a huge savings, but I made several angry calls anyway and even sent an appeal twice to blue cross (which they denied both times). I'm so glad this crap is finally coming to an end, but the right-leaning supreme court makes me afraid some of these laws will get reversed.
When we had our first child, we carefully selected a pediatrician that was covered by our insurance. It turns out that doctor was only billable to our insurance for delivery, any follow up visits were not covered by the insurer because that same doctor was not considered part of that hospital org. The org she did routine pediatric work was somehow different, yet in the same building. We discovered this as we were leaving the hospital and scheduling a follow up visit. It was very urgent since we had a moderate complication and need a doctor immediately. However our insurer (employer provided) was blacklisted by the doctors group that all doctors in our neighborhood were a part of. Ultimately, on short notice we found a new pediatrician an hour away which began ordering lab work. This is not something you want to go through with a newborn and a new mother. It was also bullshit, because we were hit with a surprise caveat to our researched doctor so late in the process even though we had been trying to do our due diligence to get things squared away months in advance.
This was all because our insurer decided that our doctor was billed by different rules depending on what part of the job she was doing for the same patient. I've been an ardent supporter of single payer ever since.
Having gone through cancer treatment here in the USA, I have received over a dozen 'after the fact bills' over the past 5 years, sometimes over 9months after the procedure, mainly involving blood work and CT scans.
I missed one bill that came months after chemotherapy for $87 in 2015, it only had a 60 day notice before sending to collections. Mind you I was on disability from my employer that paid well. -80pts on my credit score...
It took until last year to get my credit score back to the same level it was prior to starting treatment.
If it's any consolation, that time should now be 180 days, and I'm pretty sure the counter should start at the time the collection agency receives it, not from the date of service.
Another thing that is needed urgently is uniform pricing. Today healthcare providers charge different amounts to different insurers, and if you don't have insurance you pay list price. The list price is a arbitrary large number (often 3x the price insurers pay) that has no relation to reality. So if you don't have insurance, you are hit with a double whammy: You have to pay the bill yourself, and if that isn't bad enough, they charge you 300% of the "real" price, meaning what insurance companies pay for the same procedure.
I wouldn’t be surprised if hospitals already have other ways ready to screw people over once this goes into effect. As far as billing goes in my view they are basically criminal organizations that use fraud, intimidation and other things to squeeze people for money.
If the underlying problem (in-network discounted rates for services and out of network excess that the service provider can charge - honestly this practice should be made criminal - imagine Sams club selling a computer to non-members for 10x the cost the members pay) is not addressed, the surprise bill just becomes someone elses prolem (other patients end up paying).
> imagine Sams club selling a computer to non-members for 10x the cost the members pay
I wouldn’t mind that actually. They can sell for 100x for all I care. I can just not buy it. A better analogy would be if you got a letter 2 months after you shopping visit telling you that the the package of cheese you bought is actually $2000 instead of $5, and no, they do not accept returns.
California has such a law already. I went to an ER at the beginning of the year for a minor fracture and had a "contract physician". I was pleasantly surprised when the bill was exactly my er visit copay. I had an equally unpleasant experience several years ago that cost me thousands of dollars.
The CA law is kind of BS. My partner went to see doc, they ran a few tests, told her it would probably be covered by insurance and then we got a bill for $1700. They said it wasn't "surprise" bill because it wasn't out of network. I told them "it is a surprise to us!"
From then on, we always ask the cost of every single test/procedure. (In fairness to the hospital, they did give us a $50/month, interest free payment plan.)
Imagine buying a car when the salesman cannot tell you the price, and the lender cannot tell you the interest rate, until after you have driven the car off the lot.
There is no such thing as a surprise medical bills ban. The only thing that will happen, without a complete overhaul of the way medical services are paid for in the US, is that patients will be given one extra form to sign before being allowed any services by any provider:
Patient waives any and all rights granted by [anti-surprise laws]
and agrees to indemnify Provider for any related costs.
You have to understand it's not just about the rules, medical insurance companies will do plenty to stay compliant but they'll still screw you. Sometimes they'll send you a bill for something they already said was covered, then suddenly it's on you to fight a several billion dollar company into just doing what they promised.
This essentially takes the patient out of the loop if one of the providers is not in-network / being directly reimbursed by insurance. Now the provider and insurance company have to work together to resolve the bill. Most importantly it would be charged against the patient’s in-network deductible.
It’s really too bad that this bill was watered down in one particular way. The Senate version of the bill would have set the price as the median in-network price for the procedure/service in that market (which ~5x the price that Medicare would pay). Out of network prices are usually another ~5x higher than in-network prices. House Democrats instead pushed for the rate to be set in arbitration, which is the version that will be enacted.
[+] [-] jsperson|5 years ago|reply
[+] [-] lordnacho|5 years ago|reply
How do courts uphold this? You go to a restaurant, they say you can buy the tasting menu for $100, but they have a temp chef working that day which will cost you $50 extra, which you find out as you're paying.
I mean you might even be unconscious when this is happening?
EDIT
Actually someone brought up an important point. If you go to a restaurant, you are kinda expected to know that there's taxes and tipping to pay. Do the US courts think the same of healthcare? "You were in a hospital, you should have known that the bill is always higher than the sticker price?"
It would surprise me as a European.
[+] [-] harperlee|5 years ago|reply
Also not reasonable, so at least in Spain the menu has to include VAT.
[+] [-] freeone3000|5 years ago|reply
[+] [-] amelius|5 years ago|reply
Perhaps we should be wearing tags with the amount of money we're willing to spend on a hospital visit.
[+] [-] spaetzleesser|5 years ago|reply
In the US you go to a hospital and basically sign a contract "you can charge me for whatever you feel like". What surprises me is that they get away with often charging for stuff that never happened. When you confront them they just say "Oops!" ad take it off only to try it again next time. I don't understand how they get away with that.
[+] [-] nottorp|5 years ago|reply
[+] [-] kayodelycaon|5 years ago|reply
If this doesn’t describe evil, I don’t know what else would.
[+] [-] hodgesrm|5 years ago|reply
[1] https://www.washingtonpost.com/news/wonk/wp/2017/12/18/this-...
[+] [-] Phenomenit|5 years ago|reply
Private prisons seem awfully close to slavery/indentured workers.
[+] [-] unethical_ban|5 years ago|reply
[+] [-] leetcrew|5 years ago|reply
it's my understanding that the affordable care act requires insurers to treat any emergency services (if covered at all) as in-network. can anyone explain either a.) how I am wrong, or b.) how this can be circumvented?
[+] [-] tthun|5 years ago|reply
[+] [-] tsjq|5 years ago|reply
[+] [-] Dirlewanger|5 years ago|reply
[+] [-] OminousWeapons|5 years ago|reply
For example, I was finishing up an advanced degree program between September and January and my University decided to terminate my health insurance in September. Without telling me. In the middle of a pandemic. When I discovered this last week, I attempted to buy health insurance directly from insurers and was informed that I could not get coverage until January 1st of 2021 as I was "outside the eligibility window". They literally won't sell active coverage to me at any price. Apparently you only have two months after losing your insurance to be able to buy new insurance before having to wait until specific times in the year. I can buy home insurance, liability insurance, car insurance, and any other type of insurance whenever I want but god forbid I try to buy health insurance 61 days after an arbitrary point in the year. I effectively cannot go outside until January 1st as if I get covid and have to go to the hospital I'm screwed.
[+] [-] zaroth|5 years ago|reply
There are several qualifying events to be able to enroll outside the eligibility window if you’ve had a job change for example.
[+] [-] crazcarl|5 years ago|reply
[+] [-] wes-k|5 years ago|reply
[+] [-] HeyImAlex|5 years ago|reply
It’s wild that individuals are forced to navigate this system, much less fight it when they’re being fucked. The idea that there are people who’s sole purpose is designing beurocratic gears to grind money out of sick people makes me sick. And they employ an army of low wage call center folks to do their bidding, work that I can’t imagine is super rewarding. How much better would the world be if we tore down these machines and paid all of those people to do literally anything else?
[+] [-] standardUser|5 years ago|reply
[+] [-] nineplay|5 years ago|reply
While the bill is working it's way though insurance we'll get new bills, every week or so, "We have not received payment and this account will be sent to a collection agency." Call the ambulance company and they say "oh nevermind, it's marked pending".
It's a scam. They want to scare you. They want to scare you out of getting a negotiated insurance rate. They want to scare you into paying before the insurance comes though. They want you to have to call them and fight to get your money back after insurance pays
[+] [-] GOONIMMUNE|5 years ago|reply
[+] [-] spaetzleesser|5 years ago|reply
[+] [-] dandersh|5 years ago|reply
On a somewhat related note in the span of 10 years the cost to us to deliver our kids doubled. Same hospital too.
[+] [-] tyoma|5 years ago|reply
However even local government is getting in on this revenue stream. The last ambulance bill I saw (for a relative) was from the city’s fire department, which is already funded by (fairly high) property taxes.
[+] [-] HenryKissinger|5 years ago|reply
https://www.independent.co.uk/news/world/americas/us-electio...
[+] [-] Moodles|5 years ago|reply
[+] [-] henrikschroder|5 years ago|reply
And yet, there's a huge amount of Americans who have only ever lived in the US, who are certain the US system is the best in the world, and who believe all the scary stories that are designed to make you think so.
You could listen to the people who have actual real-world experience, or you can listen to the lobbyists who are paid to preserve the lucrative US system. How is this even a thing?
[+] [-] unknown|5 years ago|reply
[deleted]
[+] [-] jdlyga|5 years ago|reply
[+] [-] y-c-o-m-b|5 years ago|reply
The part that pissed me off was I KNEW about the practice and specifically made a fuss about making sure everyone in that OR was IN NETWORK. I went to an in network facility, my surgeon was in network, and so was the anesthesiologist and every person that entered my hospital room I asked if the OR staff was in network (the answer was always yes). 1 month later I get a bill for a neuro-monitoring team and an assistant-surgeon that were both out of network.
The assistant surgeon charged me about $500. The neuro-monitoring team sent a ~$20,000 bill with the promise that they'd lower it to a reasonable value when I called to pay. Furthermore Blue Cross sent me a letter saying it wasn't pre-approved (even though the procedure was) and they would not cover a cent of it. Imagine the feeling of doom wondering just how low could these shysters possibly go from 20k. Thankfully that turned out to be true, the final bill was $800. Which still made me furious because I made such a huge deal out of not getting into this situation.
So that was $1300 total out of pocket that I was not expecting to pay. Luckily I'm a software developer with a huge savings, but I made several angry calls anyway and even sent an appeal twice to blue cross (which they denied both times). I'm so glad this crap is finally coming to an end, but the right-leaning supreme court makes me afraid some of these laws will get reversed.
[+] [-] chapium|5 years ago|reply
This was all because our insurer decided that our doctor was billed by different rules depending on what part of the job she was doing for the same patient. I've been an ardent supporter of single payer ever since.
[+] [-] ativzzz|5 years ago|reply
[+] [-] bearjaws|5 years ago|reply
I missed one bill that came months after chemotherapy for $87 in 2015, it only had a 60 day notice before sending to collections. Mind you I was on disability from my employer that paid well. -80pts on my credit score...
It took until last year to get my credit score back to the same level it was prior to starting treatment.
[+] [-] JacobSuperslav|5 years ago|reply
[+] [-] AdmiralAsshat|5 years ago|reply
IANAL, though, so don't quote me on that.
[+] [-] flowerlad|5 years ago|reply
[+] [-] pxeboot|5 years ago|reply
Unfortunately, this is only one of many significant issues with US healthcare.
[+] [-] spaetzleesser|5 years ago|reply
[+] [-] tthun|5 years ago|reply
[+] [-] xyzzyz|5 years ago|reply
I wouldn’t mind that actually. They can sell for 100x for all I care. I can just not buy it. A better analogy would be if you got a letter 2 months after you shopping visit telling you that the the package of cheese you bought is actually $2000 instead of $5, and no, they do not accept returns.
[+] [-] erlapso|5 years ago|reply
From 2022 and no ambulances. This is a joke..
[+] [-] mcshicks|5 years ago|reply
https://dmhc.ca.gov/Portals/0/HealthCareInCalifornia/FactShe...
[+] [-] kevinofe|5 years ago|reply
From then on, we always ask the cost of every single test/procedure. (In fairness to the hospital, they did give us a $50/month, interest free payment plan.)
[+] [-] uberdru|5 years ago|reply
[+] [-] wmeredith|5 years ago|reply
[+] [-] tehwebguy|5 years ago|reply
[+] [-] etskinner|5 years ago|reply
[+] [-] zaroth|5 years ago|reply
It’s really too bad that this bill was watered down in one particular way. The Senate version of the bill would have set the price as the median in-network price for the procedure/service in that market (which ~5x the price that Medicare would pay). Out of network prices are usually another ~5x higher than in-network prices. House Democrats instead pushed for the rate to be set in arbitration, which is the version that will be enacted.
https://www.forbes.com/sites/theapothecary/2020/02/19/house-...