
How a $175 covid-19 test led to $2,479 in charges - hhs
https://www.propublica.org/article/how-a-covid-19-test-led-to-charges
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seibelj
Check out the book Overcharged if you want a fairly quick read that explains
the healthcare scam from top to bottom [https://www.amazon.com/Overcharged-
Americans-Much-Health-Car...](https://www.amazon.com/Overcharged-Americans-
Much-Health-Care/dp/1944424768)

Easiest way to get rich in America is to start a health clinic and start
billing Medicare. Absolute trash from top to bottom.

~~~
spaetzleesser
It’s hard to understand how the basically fraudulent billing practices in US
healthcare are viewed as acceptable and nothing gets done to correct things. I
know many people who have stories of people being overbilled by not a little
but by a multiple of the normal price. Or the hospital bills for things that
never happened. That while the patient never got an estimate upfront. There is
basically no way to do it “right”.

And even when you discover a problem you are expected to spend countless hours
on the phone negotiating between provider and insurance.

I can’t imagine any other industry getting away with such a persistent track
record of bad behavior.

~~~
ukd1
This is why I love Kaiser (kp.org) as they are the insurer and the provider.
They haven't over-billed themselves with care for me or friends.

~~~
athms
Except they don't provide adequate mental health care even with the parity
law. It takes about a month for your consultation and they funnel everybody
into group therapy and/or drugs. Only those with severe mental disorders are
given access to a shrink and only every 3-4 months. If you want weekly or
biweekly visits to a psychoanalyst, you will be paying out of pocket.

Also, as much as Kaiser likes to call themselves a non-profit, the doctor
group is for-profit. Kaiser is actually composed of three separate legal
entities: insurer, hospitals, and doctors. Any profit left over at the end of
the fiscal year is split evenly by the hospital and doctor groups, with the
doctors engaging in profit sharing. There is an incentive to provide less care
to those paying out of pocket for the insurance because the doctors will reap
a bigger bonus. This is not the case for Medicare and Medicaid recipients
because reimbursement is based off both treatment and outcome metrics.

~~~
shajznnckfke
A “shrink” means a psychiatrist, and a psychiatrist is how you get drugs. So I
feel there is some conflict in your answer where you say they funnel people to
drugs and also it’s hard to see a psychiatrist.

In my case I went to Kaiser and it took a few weeks to get to see the shrink,
who gave me drugs.

If you’re looking to have your health insurance cover therapy, I agree that
Kaiser is the wrong choice. I also saw a therapist for a while, who was
covered by my employer’s EAP (a separate benefit from health insurance).

I didn’t think most insurers would cover regular visits with a psychoanalyst.
I thought they were a pretty rare resource, so if people with insurance had
free access, wouldn’t they all be fully booked?

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jarym
I live in Europe and I never understood the in-network and out-of-network
concept (I know what it is, I just see it is ripe for abuse).

So I wonder, why hasn't Congress enacted legislation to put a ceiling on out-
of-network charges to (say) 2x the median in-network charge?

~~~
34679
Copying another comment that was downvoted out, because it is 100% accurate:

> why hasn't Congress enacted legislation to put a ceiling on out-of-network
> charges

Because they are bought and paid by the same people profiting off the system.

~~~
icedistilled
>Because they are bought and paid by the same people profiting off the system.

I know broad sweeping characterizations feel good and are easy, but I can't
help but feel they help those taking the most money from lobbyists hide from
view. And I can't help but feel they encourage giving up entirely on
government and voting in outsiders regardless of their actual qualifications,
who double down on the problems instead of fixing them.

It takes a lot more effort to name some specifics either rules or people, but
broad sweeping statements don't usually help.

~~~
34679
Sometimes broad problems demand broad statements. We could get into the
specifics of the two-party duopoly and the legacy of kowtowing to healthcare
and health insurance industries, but the examples are far too numerous and
stretch back far too long.

I will provide two examples, one from each party, so as to be less divisive:

Affordable Care Act: Democrats controlled the house, senate, and presidency.
They could've passed any bill they wanted. Instead of medicare for all or
similar, they passed a bill that required everyone to purchase a 3rd party
product called insurance. The overhead and profits of the insurance industry
add to the cost of actual healthcare.

National Health Planning and Resources Development Act: Nixon signed this in
1974. It mandates that anyone trying to build a healthcare facility apply for
and receive a Certificate of Need. This creates local monopolies for existing
healthcare facilities by eliminating new competition. It's a blatant form of
protectionism.

~~~
bobthepanda
To pass ACA the Democrats needed 60 out of 100 seats in the Senate and they
had 58. To pass it they caucused with two independents, and one of them, Joe
Lieberman, specifically would not vote for it if it had a public option.

~~~
34679
They needed 60 to avoid a filibuster. A filibuster would've required
Republicans to obstruct the vote by speaking continuously on why Americans
don't deserve healthcare. Democrats had them backed in a corner. All they had
to do was propose a bill that benefited everyday Americans instead of
corporate backers and they would've made the Republicans look like absolute
fools for speaking endlessly against it. A filibuster only lasts as long as
the opposition keeps debate open.

~~~
bobthepanda
The Overton window wasn't that far left in 2009. A good deal of the Obamacare
messaging was focused around telling middle class Americans that no, they
would not lose their existing employer-provided coverage. And even if you
could pull out all the data that would show that Medicare for All benefited
people more than existing coverage no one would've believed it.

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coldcode
Whereas in most countries on earth it costs the testee nothing directly.

~~~
verroq
The US government should be handing out those tests free.

~~~
nrmitchi
The US government _especially_ should be handling out tests for free, even if
other countries or places in the worth charge a nominal amount.

The US though is has two main problems that make any sort of charge
ridiculous:

First, there is a larger-than-normal section of the population that apparently
believes the entire pandemic is a "giant hoax", and _most likely_ won't get
tested anyways. Any charge at all would be s further hinderence

Second, and most importantly, the US medical system has lost all trust when
there is any charge whatsoever (such as in the related article), but more to
the point, the system has lost all trust when there is any possible way that
they could actually bill you.

In the US I don't care if you tell me that something is going to be $5, or
$50; if there is _any cost at all_, which means that _they have some way of
billing me_, I have to operate on the assumption that I will at some point get
mailed a bill for X thousands of dollars.

~~~
the8472
> if there is _any cost at all_, which means that _they have some way of
> billing me_, I have to operate on the assumption that I will at some point
> get mailed a bill for X thousands of dollars.

At least that particular issue could be avoided by making it a cash
transaction.

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xyst
Freestanding ERs are the payday loan scams of the health industry.

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bb88
“You can’t do that. It’s insurance fraud for you to pay for our services once
we know you have insurance.”

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mnm1
It's unbelievable to think that the government couldn't even roll out the free
testing. The most basic part of fighting corona and they couldn't even get
that right. At least now we can stop pretending we don't live in a third world
country. No wonder the pandemic is so bad here. Literally nothing is being
done. If it's this costly and hard to get a test, we have no hope whatsoever
other than a vaccine that may never come. Barring that, it's herd immunity and
all the disability and death that comes along with that. Great job of the
government to protect its people. A police state with some of the most far
reaching powers this side of traditional authoritarianism, and they can't
enforce mask wearing and business closures. But they have no problem arresting
people for smoking weed or murdering people by kneeling on their necks.
America has finally become great, the number one country it believes in
delusion to be. Too bad that number one position is in the number of corona
cases and deaths. Then again, what can one expect from a third world country
even its own president called a "shithole"?

~~~
wil421
It’s not that the government couldn’t roll out testing they don’t want to
test.

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bsenftner
Satanically criminal, yet legal in the United States - USA #1? What a sad joke
this "united" states is.

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mindslight
These articles always leave out whether and how much the person actually ended
up paying. Being an attorney, she should not have paid more than $175.

Medical providers get away with playing price roulette under the theory that
when you show up and ask for help, they're entitled to fair compensation for
their services. Their billing department then goes to work manufacturing a
bill that justifies "costs" much higher than they actually incur, and there is
no specific way to refute them.

But in this case, she had a contract for those services at $175. The provider
can't just decide that they deserve more than their contracted rate and send
her an additional bill. That would be like going to the grocery store, paying
your total at the checkout, and then receiving a bill in the mail for the
cashier's time under a theory that you had only paid for the food.

Since the victim here is an attorney, writing a strongly worded letter
repudiating the fraudulent bills should have come naturally. Did she do this?
Did the provider then go to court and successfully substantiate their fraud,
or what?

edit: I don't know what the downvotes are for.

Reading the article again, I guess she ended up punting to insurance and so
far has personally paid $0. Although her insurance states that she may have to
pay "up to $600", so the matter doesn't seem over. These stories always lack
so much agency, its frustrating.

The cost disease is a problem, and it seems none of the businesses involved
have an incentive to reign it in. Apart from the future possibility of single
payer, cash payers are currently one of the few checks on the market. But the
dynamic is never fully explored - just because someone sends you a bill does
not mean you have to pay it!

~~~
pessimizer
My downvote is partially because you seem to be objecting based on what you
think "can't just" happen, rather than on observations of what did happen, or
citations of relevant law.

Additionally, you have specific objections based on what you've decided that
this specific person should be capable of and what should come natural to
them, and also assuming that this action would be productive (rather than
costing more than $2500 to see through.) Seeing as the larger question isn't
about how much _lawyers_ are charged, but how much _people in general_ are
charged, it seems like a irrelevant observation.

I don't think you meant to sound like this to anyone, and I think we're
probably on the same side of the issue. To me, getting bogged down in
specifics is an enemy to systemic change (only when the specifics don't
threaten to contradict the general case - when they do, specifics are of
course important.) If I know of a good way for a _particular person_ to get
out of an irrationally inflated medical bill, that's really something that I
should be communicating with that person. If I see that _people in general_
don't use a good method (that I am personally aware of) to get out of
irrationally inflated medical bills, then either 1) the system is broken
because it's not automatically funneling people toward that method, or 2) if
everybody used that method, it would start to fail, which means that the
solution was never a universal one.

~~~
mindslight
Thanks for responding. I agree you can go from what I said to "the system
works there is no problem", but that is certainly not my intent. Unfortunately
flipping between different paradigms (individual action vs collective action)
is always going to feel like this, because it is exactly what politicians get
paid to do to us. This tendency to judge other-paradigm thinking as
justification for corruption is a cause of our polarization.

I have personally been in this situation, but for much smaller stakes ($80
initial quote, $50 agreed-upon xray charge, $120 surprise charge at the end).
I complained, they dropped it a bit, and I rolled over and paid it on the spot
because I was in the process of administering an estate and didn't need more
paperwork to save $70. So yeah, life can certainly get ahead of all of us.

But this isn't a friend telling me her story while I'm telling her she's
wrong, but an example that has been elevated to a news article. What is the
article's overall point - the healthcare industry is corrupt and Covid is yet
another opportunity for a cash grab? We already know that!

To the extent that my basic explanation in terms of contracts is incorrect
because there's some Texas statute that allows healthcare providers to engage
in surprise billing even when there is a contract, then this article really
needs to cite it - scrapping that law would be a direct path to reform!

If there is no such law, and this has just developed by custom, then these
articles need to investigate what happens when you litigate this. Imagine
widespread form letters to repudiate fraudulent debts - half of these cases
would disappear overnight.

Otherwise we're left sitting and just waiting for single payer, which will be
yet another corporate cash grab. I do think single payer is the way forward
(let patients deal with one bureaucratic nightmare instead of being trapped in
between two of them), but if you think it's going to be some straightforward
sea change then check out how Medicare Advantage plans work.

