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Why does it cost 100k for treatment for a heart attack anyway? I think the root cause isn't the insurance itself (but they don't help matters). What good is insurance if it covers 80% of a 100k bill... if in reality, the cost of your healthcare was really 10k? I'd rather pay 10k out of pocket for 10k of medical services than 20k as a copayment on a bogus 100k bill.
ER visits are one thing, I get that. Split second decisions need to be made where it isn't possible to sort out insurance at that moment. However, for many treatments and doctor visits - all of a non-emergency nature - why can't these prices simply be posted? What other business establishment do you go into for service and not have any idea of the cost? I don't go to a barber and get my haircut and then have the guy or girl say "Hey, I had to use a different scissor than I thought I would, therefore it isn't $20 it is $80. Sorry I didn't tell you beforehand."
For common procedures or treatments, the signs should be posted as if it is a fast food restaurant. Sorry for the comparison, but it seems completely backwards that we get treatment and have NO idea what the cost will be. None. Even worse, there are times when the people working in the billing department can't even tell you. I've tried that before. It doesn't help that a procedure might be $300 but I might pay $0 or I might pay $300. That's a big range.
My daughter had some test done years ago for some type of weird allergy she had that was never really figured out. At the time, things were tight. I asked the people in billing "how much will this cost?" They entered the code for that test and said "$250." $1500 later, I'm inquiring with them why it cost that much. No answer. Really. They simply don't know. They punch in a code for a treatment and there's a number, $250. Why was it $250, they have no idea. Why was it inflated to $1500? Apparently that cost came from how the doctor decided she could not analyze the test results herself, so she sent it to a specialist. And that specialist demanded $1250 for 10 minutes of work. I'm sorry, but if that first doctor could not do their own job, then they shouldn't offer the service or pass along the cost to me.
Costs are definitely a problem and should be posted publicly. If one has insurance the difference between what gets billed and what is actually contracted to pay by insurance is baffling to me.
Costs are definitely a problem and should be posted publicly. If one has insurance the difference between what gets billed and what is actually contracted to pay by insurance is baffling to me.
Costs, billings, what you pay OOP and what your HC insurance pays are all part of a desirably arcane payment system. Both hospitals and insurance companies want to continue with all the smoke and mirrors, as it improves their chances of net monetary gain. This would only go away with a centrally controlled UHC/single payer system, which I do not support. Although for many they might consider this a better solution.
In general I find that you can get basic pricing on most simple and easy. uncomplicated medical encounters. Things like simple office or urgent care visits. pre-approved procedures like routine colonoscopies, or gall bladder removal with a relatively young and healthy patient. But as so much becomes uncertain with more serious or complex medical conditions it becomes progressively harder to give a price.
For instance the patient with an acute chest pain/heart attack. In the ER it will take some time, testing and expense to work up that patient and risk stratify to see if it's a benign condition requiring a brief observation or treated with a GI cocktail, or a full on ICU admit along with interventions, immediate or otherwise.
A $100K bill is no too far out of line if you've been there and seen all the necessary stand by staff, equipment, training and technology that goes into a short, but very intense heart attack admission. Or it could be $1000 or so if the episode turns out to be benign.
I'm sure we'll be seeing a bunch of "do your research to make sure the doctor is in your network" posts here. Kinda hard to do that when you are having a heart attack.
If you have to do research into what doctor you can/cannot visit, maybe there's something fundamentally wrong with our healthcare system.
This is why I so gleefully await the horrible karma that they so richly deserve. I won’t shed a tear for those people.
Just don't pay the bill! Once the hospital sells it to a collection agency, you're off the hook! You're under no obligation to pay a collection agency and after a set number of years, depending on the state, if they don't collect and can't make contact with you, the debt goes away!
Quote:
Originally Posted by middle-aged mom
Depending on the amount, the hospital or debt collector may pursue a judgment in court, wage garnishment and/or lien on assets.
The debt will likely impact your credit score and ability to/interest rate you pay going forward.
This.
Any non trivial amount will be pursued. Here in Jersey you wont even find out when the court date was because the judges sign the garnishments en masse.
Extremely familiar with balance billing due to having a daughter with a very rare medical issue. When there’s only five doctors in the country with the capability of working on your child or it’s an absolute emergency, in-network is a moot consideration. That said, I’ve always been able to work it out whether via the insurance company, the hospital, or both. Is it a headache and more paperwork? Yes. But it’s never been an impossible situation and my first instinct is not to run to the media when I see that first bill. Oh and removing a tumor in someone’s head? Cost a hell of a lot more than this bill. Ultimately it sounds like the bill was reduced to ~$700. So really a bit of a non-story after all. Again, it all worked out.
I can see lots of room for improvement in our medical billing (that’s really the problem, you know). I don’t think ACA has helped and actually made the problem worse. I don’t think universal is the answer as I’m well aware of wait times and frankly, I’m not willing to let my kid have to suffer so long like others with her disease do in other countries with socialized care.
Remember when county hospitals was where you went for non-insured care? Wasn’t perfect but it was an option - why is that no longer viable? They were strictly non-profit and left private hospitals to those with insurance. I wouldn’t even mind if we had a very basic “insurance” option that covered catastrophic care only via our taxes. But if you want more, buy that gap insurance and it shouldn’t be mandated plans. You want more that includes maternity, get that plan. You want more that includes low co-pays, get that. A very free market answer to a for profit system while catastrophic care could still be covered via some taxes and having some non-profit hospitals again like we used to.
But let’s get real, Democrats think everything comprehensive is the minimum that must be covered. That’s why they will never get the rest of America to buy in. Basically they asked for the moon while trying to tell us it wasn’t - they’re just pissed people didn’t believe them
You seem to conflate / confuse Universal Healthcare with Single Payer which is one of many strategies some countries choose use to implement Universal Healthcare.
The rest of the developed world has Universal Healthcare. No two countries do it the same way. Some rely entirely on Private ( Insurance) Payer. Some rely on Single Payer. Most are a mixed bag.
Some countries rely mostly on government- owned and/ or operated hospitals. And some rely mostly on private hospitals.
Some countries with Single Payer do not function under a National Healthcare System. Most of the Nordic countries with Single Payer function at the municipal level.
The US is ranked #3 in terms of access to Specialists, after Switzerland and The Netherlands. Geography within a country matters. The more remote/ rural areas do not have the populations to support the same level of healthcare services as do densely populated urban areas. This is not unique to the US.
Wait times occur when there is an imbalance of supply and demand in a geographical area of a country. Most times it’s a temporary imbalance and impacts elective surgery. Unfortunately, when there is an excess of capacity, it can’t be saved for times when there is a deficit.
The concept of Balance Billing seems rather unique to the US. Not everyone is as fortunate as you or this teacher was in terms of negotiating a settlement of Balance Billing. Not every hospital system attempts to charge multiples of customary fees for service as the teacher’s hospital did. And it looks like that hospital has a track record of doing so.
My husband has had several healthcare issues related to Cancers and blood counts. He experienced wait times for surgeries. The doctors he sees for annual follow- up have wait lists in excess of 6 months. We live in a highly competitive healthcare market.
Our BCBS insurance is very good and he has yet to encounter an out of network Balance Billing situation. The hospital healthcare system we use does not allow out of network providers to operate on their premises.
There is no such thing as free healthcare anywhere. County hospitals are funded by counties/ states and the Federal Givernment out of general revenues and deficit spending. County hospitals don’t have all medical specialties on staff. The wait lists for Some treatments , if available, are subject to demand/ supply.
So many of the diagnoses that used to be fatal are now treatable and often times, survivable.
Given your daughter’s medical situation one would think you would have a deeper appreciation for one of the most critical features of the ACA - your daughter cannot be denied insurance based upon preexisting conditions. Imagine had you lived in a state that allowed its insurers to reject those with a history of medical conditions they chose not to insure with an unlimited look back period.
Costs, billings, what you pay OOP and what your HC insurance pays are all part of a desirably arcane payment system. Both hospitals and insurance companies want to continue with all the smoke and mirrors, as it improves their chances of net monetary gain. This would only go away with a centrally controlled UHC/single payer system, which I do not support. Although for many they might consider this a better solution.
In general I find that you can get basic pricing on most simple and easy. uncomplicated medical encounters. Things like simple office or urgent care visits. pre-approved procedures like routine colonoscopies, or gall bladder removal with a relatively young and healthy patient. But as so much becomes uncertain with more serious or complex medical conditions it becomes progressively harder to give a price.
For instance the patient with an acute chest pain/heart attack. In the ER it will take some time, testing and expense to work up that patient and risk stratify to see if it's a benign condition requiring a brief observation or treated with a GI cocktail, or a full on ICU admit along with interventions, immediate or otherwise.
A $100K bill is no too far out of line if you've been there and seen all the necessary stand by staff, equipment, training and technology that goes into a short, but very intense heart attack admission. Or it could be $1000 or so if the episode turns out to be benign.
I agree with the bold. However every little thing has a code which has a dollar figure attached to it. Not publishing those dollar figures is how they get away with it. So whether an intense or benign visit happens the $ would be known by a simple check. Perhaps it would make them more accountable as well.
If they are to stupid to know what's in their insurance.
They are to stupid to decide what insurance everyone else should have too.
Talking of stupid, did you even read the article? The hospital was in network. He was seen by a doctor who wasn't. This is a very common scam and needs to be regulated since it is very rarely in the control of the patient. I've twice had a similar situation, where a random person attended during a hospital visit, and I ended up with a bill that was not of my choosing, due to the attending person (not all are doctors BTW) not being part of the in-network staff. This is a crazy situation where there is no choice, since there are people coming in and out all the time and they don't have "Not in Network" printed on their forehead.
Just don't pay the bill! Once the hospital sells it to a collection agency, you're off the hook! You're under no obligation to pay a collection agency and after a set number of years, depending on the state, if they don't collect and can't make contact with you, the debt goes away!
Some people think the problem is that this teacher got a bill for $108,951. My problem is not that the teacher got the bill, but that the bill was $108,951. Costs are out of control and arguing over who pays the bill is not going to solve that problem.
Just a reminder how F up our health system is. If you end up getting treatment form a hospital that is out of network or even if you are in an in-network hospital but the physician treating you is not in-network; you can end up in financial ruin.
This is one of the most stupid, f'ed up parts of our healthcare system, and this is the kind of thing that drives Independents like me crazy when some hyper-libertarian politico gets all ideological about an issue that's fundamentally about corruption, terrible policy and waste that's unique to United States healthcare system. This is what a lot of opponents of universal healthcare system don't understand, even if you do have a good job and good health insurance in the USA, you still get shafted because the system is designed to shaft you, rip you off and bankrupt you for things completely outside your control, and this balance billing out of network BS is some of worst of it. There's nothing "conservative" about a healthcare system that leaves people stuck in this uncertainty at risk of losing hard earned savings over a dumb medical bill, it's just stupidity and poor policy. What is the point of paying already sky high premiums and deductibles if you still get shafted anyway?
Essential and emergency care especially should be completely covered regardless of insurance status. And the link between health insurance and a job should be cut forever. Makes no sense to tie health insurance to a job when people are constantly changing jobs. Or working as contractors, why in world should a hard working contractor have trouble with health insurance access? Not to mention it, the US now has the worst rate of business starting in our history, we're now mediocre, we're like below a lot of poor countries in Europe and South America for starting businesses because Americans are too scared to leave a big company job to start a business when they don't have health insurance. And even if you do have a "good job" like this example shows, you still get shaft if you get sick. The rest of the world is laughing at us for this, even many third world countries have better healthcare.
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