
Girl’s $143k bill for snakebite treatment reveals antivenin price gouging - pseudolus
https://arstechnica.com/science/2019/04/try-not-to-get-bitten-by-a-snake-it-could-cost-you-143000/
======
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...

~~~
umvi
I mean, you are also seeing the extreme cases float to the top because
articles like these attract anecdotes. It's hard to tell how widespread the
problem is because people who pay a more reasonable amount for stitches don't
comment in these kinds of threads. For all we know this only happens .1% of
the time

FWIW, I've never had such extreme bills. The largest bill I've received in the
last few years was $2000 for my wife's epidural, but I only paid about $400 of
it (insurance paid the other $1600)

~~~
falcolas
Most people hand it off to insurance and don't look at it twice. My parents
have a story of looking at a _paid by insurance_ bill that included $2,000 for
two ibuprofen pills. They questioned it, and everyone involved (including the
insurance company) said "why do you care, insurance pays for it?"

~~~
mixmastamyk
They don't pay list prices either, and have negotiated something much less.
The list prices are basically a fantasy hoping to gouge the unknowing, while
the rest of us feel like we got a discount.

~~~
378fho
It's simple fraud in many cases.

Patient has a 20% copay. The provider bills $100,000. The provider "pays"
$80,000. The patient pays $20,000.

Provider then pays a $70k kickback disguised as a discount on other charges,
fees for participation in the system, etc. (or never even pays the EOB
amount). In fact a total of $30k is paid for the services, and 66% of that
comes from the patient.

Insurance gets away paying $10k instead of $24k (80% of $30k). Provider gets
the business by being on insurer's provider list. Patient thinks "I'm glad I
paid $20k for Insurance. My health-care-spend ended up being $40k instead of
$100k." In fact, they'd have been better off without insurance, which would
have only cost $30k.

------
estebarb
Meanwhile in Costa Rica the treatment for even more poisonous snakes would
cost zero dollars with zero zero cents (including helicopter or small plane,
if required). Here antiofidics are produced by the Universidad de Costa Rica,
and every public health center has a reserve of it. Those serums are exported
too. I really can't understand how USA got public health so wrong. Here we pay
like 9% of tax over salary and get "ALL the health cover you may need": broken
legs, cancer, HIV, transplants... You name it: each and every treatment is
free: no deductible, no coverage limits, no contractual exceptions, no
preexisting conditions, not even a call to the insurance company before
receiving treatment or having to provide your ID. Sometimes I had thought
about applying to a cool techco at USA, then I remember the health system
differences and I forget it.

~~~
commandlinefan
But that's even worse - now the $143k bill is sent to the government which
just shrugs its collective shoulders and pays it... until the money runs out.

~~~
plasma
As an Australia who enjoys universal healthcare, not once have I ever worried
about being sick financially and how much it would cost me.

I can go to any doctors I want and easily afford the medication I may need,
and may visit a doctor preemptively and without worry about cost.

It saddens me that American citizens are suffering with such an awful
healthcare system, and no where in the galaxy would I ever wish a system like
yours to enter Australia.

You should vote for universal, single payer healthcare.

~~~
jmilloy
Happily, this extended to me (US citizen) while visiting and requiring
stitches. No cost, wonderful people, even though I didn't have my insurance
card with me at the clinic and they had to take my word on faith that I would
call it in later.

------
js2
This article is part of a “bill of the month” series between NPR and Kaiser
Health News:

[https://www.npr.org/sections/health-
shots/2018/02/16/5855495...](https://www.npr.org/sections/health-
shots/2018/02/16/585549568/share-your-medical-bill-with-us)

Entire series:

[https://www.npr.org/tags/585747919/bill-of-the-
month](https://www.npr.org/tags/585747919/bill-of-the-month)

I think a handful of these have had significant HN discussion, but this is the
only other one I can find at the moment:

[https://news.ycombinator.com/item?id=18328934](https://news.ycombinator.com/item?id=18328934)

------
lr4444lr
_When KHN questioned St. Vincent Evansville hospital on its charges for
Crofab, the hospital noted that the snake-bitten girl’s family wasn’t on the
hook for the bill. Insurance covered the price of the antivenin. And, in the
end, the family’s insurer negotiated the $67,957 antivenin bill to
$44,092.87._

So it wasn't the girl's bill, it was the insurance company's. What would they
have charged the family if they were poor and uninsured? Probably a lot less
than even what they settled with the insurance company for. Yes, U.S.
healthcare is screwed up, but I don't think this case resembles what happens
to people who actually falls through the cracks.

~~~
TheCondor
Can they somehow extract this back as a tax deduction? The parties are
remarkably willing to negotiate, whereas your mortgage provider won’t move
very far at all if things get sideways. If they aren’t, I’m certain there are
ways to financially engineer things to recoup at least some of the “loss.”

~~~
nradov
Most US taxpayers can deduct medical expenses which exceed 10% of their income
(subject to some limitations).

------
mnm1
If companies can outsource jobs to other countries, we should be able to
import drugs from other countries in the same way without restrictions. It's
ridiculous that this isn't the case. This for profit drug and medical industry
in they US needs to die. One way that could be achieved is by having a single
payer system that negotiates prices. Don't want to agree to the new,
reasonable prices? You don't get to participate in the system and therefore
most patients will not be your customers. It's tiring living in a supposedly
developed nation that doesn't even have proper healthcare. That's not
developed at all and as Americans we should be ashamed of our healthcare
system that prioritizes profits over health and lives.

------
Abishek_Muthian
Living in India, near Western Ghats being bitten by snake is one of the
constant worries due to availability of anti-venom at the nearest medical
center (Which usually is state run hospital usually located in the centre of
the city). But if one is lucky to make it to the hospital, being state run,
the cost of snake bite treatment isn't prohibitive.

But as with other health care related expenditure in US, snake bite treatment
seems just as messed up.

------
caffed
Why would transportation cost 55k+ to begin with?!?!

~~~
post_break
I was in an ambulance. The bill was over 20k. This is a glorified RV. I can’t
believe the helicopter was only 55k.

------
h2odragon
Had she been bitten by a venoumous snake? TFA says "Thought to have been a
copperhead"... They don't always use their venom. My dogs kill a few every
year, they've had a couple bites but nothing serious. On the other hand I've
lost several dogs to moccasin bites.

They're not hard to distinguish from other snakes, but then again, how many
people saw that snake, had they any experience identifying snakes, etc.

Surely they wouldn't go shooting up someone with anti-venoms until they
determined whether it was necessary?

~~~
kaitai
I'm not sure about that. Trying to find the article... but rabies shots, for
instance, are very expensive and prescribed on a population level far out of
proportion to the risks. Right, here's one such article (it's a county-wide
review of prescriptions, not a huge study):
[https://www.seattletimes.com/seattle-news/health/half-of-
peo...](https://www.seattletimes.com/seattle-news/health/half-of-people-who-
get-rabies-shots-shouldnt-king-county-health-study-finds/)

------
bg4
They tried to charge me $7500 for a few stitches on my son's chin when he fell
at preschool. Outrageous.

------
ptah
kaching

------
Sahhaese
Yes, the US has a messed up healthcare system. It's terrible, but it's not
something that tech can fix. It's a political problem, so this is politics and
is disappointing to see politics at top of HN.

~~~
Retra
Political problems are mostly communication problems, and communication is
tech.

~~~
jsloss
Can you expand on your point? Because it makes no sense to me.

~~~
deadbunny
If all you have is a hammer then everything looks like a nail.

~~~
Retra
What if all you have is a human brain?

------
tathougies
So this seems to me to be an instance of the system working. For example, the
girl's family wasn't actually charged. The article notes the insurance paid
for it. Keeping the price high here helps the hospital cover the costs of
people who cannot afford treatment (I don't think this is a good sign, but it
is how our system works).

The article also notes that due to competition, the price of the medication is
now significantly lower. I guess I don't really see the issue here. This is to
be expected... if there's a cheaper drug produced elsewhere that works the
same, then it will become more used.

~~~
Avshalom
keeping the price high is why people cannot afford treatment.

