
Doctors Are Fed Up with Being Turned into Debt Collectors - prostoalex
https://www.bloomberg.com/news/articles/2018-11-15/doctors-are-fed-up-with-being-turned-into-debt-collectors
======
toomim
Part of the problem is that hospitals don't disclose prices before performing
services.

So patients must agree to a procedure -- yet only afterward find out how much
it costs. That price can be shocking, and the patient never agreed to pay it.
No wonder it becomes hard to collect from them.

In the rest of the economy, we agree on a price beforehand. That makes
customers more likely to pay.

The medical system, however, has given up on disclosing prices to patients,
because everything is paid by insurance. And now we have Doctors who say:

> “It's harder to collect from the patient than it is from the insurance,”
> said Amy Derick, a doctor who heads a dermatology practice outside Chicago.

If you want people to pay, then make an agreement with them _before_ you
perform the service!

~~~
nowarninglabel
>In the rest of the economy, we agree on a price beforehand

This occurs in auto repair as well (though maybe less than it used to). Those
repairs, in my opinion, have been quite stressful as well. Are there other
industries where we bill afterward?

~~~
TallGuyShort
Maybe find a different shop? I've had mechanics that acted the way described,
but I called around and found one that would give me an upfront price for a
diagnostic and then called back with a detailed plan for parts and labor to do
the required work. I've lived in a number of cities in the US and always
managed to find one that does this over the phone.

~~~
pmiller2
My shop does the same thing. They charge a diagnostic fee that's equivalent of
1 hour's labor and give me an estimate to fix the issue. The diagnostic fee
counts toward the repair. Sometimes they find other things when doing the
work, but I can relate: who hasn't gotten into fixing a bug and found out it's
more complicated than they thought at first?

------
old-gregg
Poor "providers"... They charged us $250 for a can of apple juice and two
Advil pills (AKA "recovery kit") after a broken wrist surgery, which itself
was $45K without a hospital stay.

No wonder they now have a "problem" having to chase non-paying people. It's
like charging $10K for a handshake and then sponsoring an article on Bloomberg
about being unable to collect it.

~~~
beckler
I occasionally get random bills from "providers", and I think it shows just
how awful medical billing is.

The worst was whenever we had our first child. I thought it would just be a
single bill or something, but instead I received about 10.

One from the hospital, one from a surgeon, one from the OBGYN, and one from an
anesthesiologist. We only met one pediatrician during our stay, but we
received a bill from every pediatrician that did a rotation while we were
there, so that added four more. One because a nurse working was an independent
contractor, and one from the wet nurse who we talked to for like 5 minutes.

Two of them we never actually received bills for because they had an outdated
address, so they were sent to collections. We discovered them a year later
when we were trying to buy a house. It dinged my wife's credit so bad that we
were recommended to not put her on our mortgage application.

~~~
ransom1538
"One from the hospital, one from a surgeon, one from the OBGYN, and one from
an anesthesiologist. We only met one pediatrician during our stay, but we
received a bill from every pediatrician that did a rotation while we were
there, so that added four more. One because a nurse working was an independent
contractor, and one from the wet nurse who we talked to for like 5 minutes."

This is it. This is the US medical scam crystallized. What you need to focus
on as a US patient is the "Out-of-pocket maximum/limit." (a number) - which is
the yearly maximum you pay as an insured person. Basically, once you enter
into an ER you are going PAY this this number. This number is reset every
January 1st. So If you have a child January 2nd -- you are in GOOD* shape --
since you will hit your yearly max ("Out-of-pocket maximum/limit.") early in
the year -- all other medical is free.

My friends that had a child December 30th, are in bad shape. They pay for
yearly "Out-of-pocket maximum/limit" two times: one for the current year and
one for the next year.

~~~
Cerium
Stories like this are what keep me as a Kaiser member. In the years I've been
with them, I've been to the ER twice and have yet to hit the yearly maximum.
Usually they correctly bill me while I am on-site, only rarely do they have a
follow up bill.

------
jedberg
Doctors being debt collectors is annoying for both the doctor and the patient,
and they're also bad at it. Just the other day I got a bill for a procedure in
July of 2017, despite 1) not having seen that doctor since 2016 and 2) never
having had that procedure. Now I have to fight with them to prove a negative,
until it goes to collections and I can make _them_ prove the debt, and then
wait for my credit to get fixed after they figure it the debt isn't valid.
Yay.

~~~
chrisjc
Agreed. Just got contacted by collections about unpaid services. Contacted the
doctor's office about this and they said our insurance denied the claim and
they couldn't get in touch with us to resolve the matter. Turns out they were
submitting to our old health insurance company, and using our old home
address. We were also at this office about 3-4 times before and 3-4 times
after the procedure that went to collections.

Tangentially, we've started to notice that doctor offices will often claim
that procedures aren't covered and we have to pay out of pocket. However, we
keep track of these out of pocket expenses since we're close to hitting out of
pocket maxes. Turns out most of the time, the doctor's offices will still
submit the claim to our health insurance company even though we paid,
effectively double dipping.

Also, the amount of time spent following up with doctors, payments,
procedures, claims, etc is mind boggling. At least 4-8 hrs a week. Getting an
answer about what is and isn't covered also seems to be some kind of black
art.

~~~
FireBeyond
> Tangentially, we've started to notice that doctor offices will often claim
> that procedures aren't covered and we have to pay out of pocket. However, we
> keep track of these out of pocket expenses since we're close to hitting out
> of pocket maxes. Turns out most of the time, the doctor's offices will still
> submit the claim to our health insurance company even though we paid,
> effectively double dipping.

Let's not beat about the bush, this is _insurance fraud_, not "double
dipping". The provider has to assert to the insurer that they have not been
paid for that service rendered when they bill insurance.

~~~
HarryHirsch
Let me guess, the Attorney General is not interested in prosecuting, because
if he were physicians would be more honest. The advice would be to let the
dubious bills go to collection, they'll never end up in court because that
would make a paper trail.

~~~
FireBeyond
The AG doesn't need to be involved. Insurers, for all their faults, _love_ to
hear about provider fraud and can make that an entirely uncomfortable
situation for the provider.

------
PinkMilkshake
Every time I read this stuff I feel truly privileged. I'm a New Zealand
citizen living in Australia. Not only do both countries have universal
healthcare, but they have a reciprocal agreement to provide free healthcare to
each others citizens.

Australia has bulk-billed doctors and there's no shortage of them. I can book
an appointment online for tomorrow, wait for 10 minutes in a waiting room and
see a GP for free. I can even choose which GP I want to see. And I'll likely
get anything they prescribe me for free as well. Medicare refunds so much
money I sometimes feel guilty because I know I can afford it.

My partner has a chronic health condition that resulted in her large intestine
being removed and she requires thousands of dollars worth of medication a
month, likely for the rest of her life. We've never paid for surgery or
medication beyond admin or prescription fees.

I want this for everyone and I pay my taxes gladly. I would pay more for an
even better system. You don't have shit if you don't have your health.

~~~
eriktrautman
Going to Australia and NZ earlier this year was when I finally had to admit
that there is absolutely no justifiable reason why we have such a shitty
system in the US. I paid out of pocket for an MRI because it was cheaper than
anything I would have gotten in the US with insurance. The end-to-end
experience was great.

I returned to find that I couldn't enroll in health insurance until 2019
unless I joined a company as a fulltime employee, resulting in a terrifying
6-month coverage gap where the only option was BOTH paying the lack-of-
coverage penalty AND paying for shit "no way they're reimbursing anything"
temporary coverage from an agency that didn't even send an insurance card. Our
system is undeniably and unjustifiably fucked.

------
mjevans
Healthcare, in America, is broken.

We need single payer healthcare for all emergency and 'standard' care
(government gets a bid on rates from practitioners in the area, and if it
doesn't like the rate, supports patients via the military systems).

That includes vision and dental; being able to see and being able to consume
food properly tend to be requirements for workforce productivity.

Cosmetic and luxury care (like cutting triage lines in non-emergencies) can be
premium services.

~~~
chrisseaton
> supports patients via the military systems

Why should the military be involved?

~~~
mjevans
Provider of last resort / "I can do it better"; the argument is generally that
private healthcare can do things better/faster/cheaper. So then why not let
the infrastructure that serves the active military provide care? Or training
for doctors beyond what civilian residency programs provide?

~~~
chrisseaton
Military healthcare is specialised for a young and healthy population of
disciplined people who report problems early and do what they’re told in
treatment. I’m not sure the results scale to civilians.

------
devonbleak
Anecdotally I just find it ridiculous that they can't charge me whatever I'm
going to owe at the time of the visit. I'm fine paying it then and there, but
when you send me a dead tree 3 months later and want me to either send a check
or write down my credit card number and send that back forget it - I'll pay
you when I see you again.

Seems like a much better solution would be for the insurance to just pay it
and then charge me the rest. At least that way I only have one entity to deal
with and they probably support online payments. And they're in a much better
position to exert leverage to get me to pay - if I'm too far behind on paying
them they can suspend my insurance whereas a care provider that I'm unlikely
to see for months or years really has no recourse other than sending me more
dead trees begging for payment.

~~~
hinkley
Or just be consistent about the bills. If I get a bill for $850 and then
another one for $1150 do I owe $1150? $2000? Have you run this by my insurance
yet?

So I just wait 60 days and go with whatever the last bill is they sent me. I
could do 30 days but I'm already pissed that they can't get their shit
together (and at the state of health care) so they can stew for all I care.

------
darawk
This is exactly how insurance and medicine ought to work. The only way we're
going to fix the costs in our healthcare system is through high-deductible
plans and transparent pricing.

> Now, instead of getting paid by insurance companies on a predictable
> schedule, health-care providers have to engage in an awkward dance. One
> moment they’re removing a pre-cancerous skin mole. The next, they’re
> haranguing patients to pay what’s become a growing portion of the total
> medical bill.

In a situation like that, why aren't they just taking the money upfront? It's
not like a skin mole is ultra urgent.

~~~
fzeroracer
Considering high deductible plans are a scam and part of the reason why we're
in this situation in the first place, I disagree.

~~~
lotsofpulp
High deductible plans are the closest thing to health insurance by definition.
Your home insurance doesn't cover routine and expected problems such as
roofing replacement or seal coating the driveway. It's for unexpected AND
unaffordable damages.

~~~
fzeroracer
I would say anything that discourages people from getting basic preventative
care is a bad thing even if in your strange world HDHP is somehow closer to
'real' health insurance.

HDHPs as I mentioned encourage people to bet against their own health, that
they will never get in an accident, or their body won't decide to crap out on
them and so forth. Additionally they defeat the entire purpose of insurance
which is that the people at risk are subsidized by the healthier people; if
you separate the two pools then the healthy pay marginally less while the
unhealthy pay a lot more.

For example, would you consider HDHPs that don't cover vaccines to be a good
or a bad thing? It's a routine checkup, yet we've established that in general
it's of greater benefit to society if we do get those routine checkups done.

~~~
darawk
> I would say anything that discourages people from getting basic preventative
> care is a bad thing even if in your strange world HDHP is somehow closer to
> 'real' health insurance.

 _Does_ it discourage that? You still want to get preventative care, because
if you don't, you'll have to pay more later. Secondly, people are still
strongly disincentivized to become sick because of the way that being sick
feels.

> HDHPs as I mentioned encourage people to bet against their own health, that
> they will never get in an accident, or their body won't decide to crap out
> on them and so forth. Additionally they defeat the entire purpose of
> insurance which is that the people at risk are subsidized by the healthier
> people; if you separate the two pools then the healthy pay marginally less
> while the unhealthy pay a lot more.

Who said anything about separating pools?

> For example, would you consider HDHPs that don't cover vaccines to be a good
> or a bad thing? It's a routine checkup, yet we've established that in
> general it's of greater benefit to society if we do get those routine
> checkups done.

Vaccines are cheap and plentiful. We already require kids to be vaccinated
before they can attend school. I'm not sure why insuring them would increase
or decrease their rates.

~~~
nikki-9696
"We already require kids to be vaccinated before they can attend school."

No, not everywhere does anymore.

"I'm not sure why insuring them would increase or decrease their rates."

Because some people are very poor. My friend didn't get her flu shot because
she couldn't afford the extra $50 this month. And that's a cheap vaccine that
doesn't also require a doctor visit to go with. Some people have to worry more
about today than tomorrow or they don't have food and rent money this month.

~~~
lotsofpulp
Everyone I know who has health insurance through employer or healthcare.gov
has flu vaccines paid for, and an annual physical.

------
pishpash
> _“There’s a burden on both sides,” said Callas. “But health-care providers
> get caught in the middle.”_

Caught in the middle my arse. This is bigly shirking the responsibility and
falsely playing the victim. Healthcare providers are extremely well versed in
the billing rules and are playing dumb when they pretend not to know. There
are literally manuals and seminars on how to bill (i.e. "code") one service as
several, or code to a more profitable option when several options are
possible, while hiding behind a veneer of respectable neutrality. Multiple
large providers have been sued for essentially insurance fraud and go back to
doing exactly the same.

It's a big business driven by quarterly numbers and providers don't hire
expensive staff to lose at gaming the system. Do _you_ as a patient have a
full-time staff to go through billing arcana for you all day? It's impossible
to even find a patient advocate. Then on top of that larger providers like
hospitals aggressively sell bills to collections agencies on any dispute,
abusing the power over the patient's credit as their first resort at price
gouging. Thank god for the CFPB and the 2015 credit reporting rule change [1].
The day of reckoning is coming and doctors need a long look in the mirror for
why they are in this line of work.

[1] [https://ag.ny.gov/press-release/ag-schneiderman-announces-
gr...](https://ag.ny.gov/press-release/ag-schneiderman-announces-
groundbreaking-consumer-protection-settlement-three-national)

------
jld
I am always amazed at how little of the total bill insurance pays for normal
visits. By the time you include copays, coinsurance, and the insurer's
negotiated rates, nearly half of what the doctor gets paid is paid by me.

~~~
FireBeyond
Pretty much. They'll argue that the negotiation is part of the "value" they
add, but beyond that in many cases they're merely rent seeking.

------
sangd
"We can't do it for free" but you can't just set any price. I dislike doctors
and hospitals for never disclosing the service fee or being truthful about
their treatments done on the patients, especially the ER ones. They often
perform unnecessary procedures and mark up the fees so high to jack up the
cost and settle with a bit less which is still ridiculously high.

------
rwbt
In any industry that involves insurance companies predominantly paying bills,
will eventually lead to out of control costs (health, auto collision repair
etc)

Higher the costs, more incentive (or mandatory) for users to buy insurance and
also more profits to insurance companies.

~~~
stephen_g
It's true - a higher proportion of cost borne by insurance companies and the
private sector is very strongly correlated with higher healthcare spending -
this is from OECD data:
[https://images.theconversation.com/files/44253/original/3y3h...](https://images.theconversation.com/files/44253/original/3y3hh26p-1395196169.jpg)

Full article - [https://theconversation.com/private-insurance-reliance-
means...](https://theconversation.com/private-insurance-reliance-means-
countries-pay-more-for-health-care-24486)

------
sergiotapia
Cry me a river. Stop charging obscene amount of money for services.

~~~
nickthemagicman
I don't know why you're being downvoted. Everyone tries to lay the problems
with healthcare everywhere else BUT the actual cost of the service.

My aunt went to the ER for a snakebite. They gave her the anti-venin and let
her stay for 12 hours.

It cost 46,000 dollars. It was a rattle snake. They do this thing all the time
in India for COBRA bites and it's not even close to being that expensive.

~~~
joecool1029
> They do this thing all the time in India for COBRA bites and it's not even
> close to being that expensive.

US Pharma would say because India doesn't care about medical patents and R&D
cost. (Not saying I agree at all, but that's the excuse given)

~~~
zaptheimpaler
Heres an article breaking down the cost of precisely that rattlesnake
antivenin [1]

Unsurprisingly, its mostly blatant money grabbing.

70% is pure markup that insurers don’t pay but uninsured do.

2% is the R&D cost. Probably for something we invented 100 years ago which
makes you wonder just how the R&D continues to cost $100+ per dose decades
after its basically perfected anyways.

[1]
[https://www.washingtonpost.com/news/wonk/wp/2015/09/09/the-c...](https://www.washingtonpost.com/news/wonk/wp/2015/09/09/the-
crazy-reason-it-costs-14000-to-treat-a-snakebite-with-14-medicine)

------
ucaetano
Patients are fed up with being turned into money bags

------
spectrum1234
Here's an idea. Make it legal to get lower quality service and pay less. Like
every other good and service.

------
yardie
Then what are these additional bills I get from Doctors service companies. I
recently paid $250 for an ER visit. That was an expected deductible as
outlined in my healthcare plan. What I didn’t expect was a separate bill from
the ER doctor for an additional $200 for a 5 minute visit.

~~~
FireBeyond
Many hospitals like to have their physicians as contractors or consultants.

For bonus points, not all hospitals require their physicians to be in the same
network as the facility, so you can get an "out of network" bill for the ER
doc at an in network hospital.

Or, to get even more ridiculous, I went to a large chain urgent care. They had
labs in house. I got a blood draw there as part of a physical from the PA-C.
And an out of network bill. Lab ABC, owned by healthcare provider ABC, inside
an ABC urgent care, was somehow out of network, in contrast to the facility
and the provider. Cue a $600 bill...

------
almostdeadguy
It's baffling to me that so many smart people on this website don't understand
how complex health insurance is or seem to think that people don't pay their
bills because they don't like the prices

~~~
sumoboy
Rich or poor, money is money and if you feel like your getting screwed there
is very little reason to feel obligated to pay when due or ever.

~~~
almostdeadguy
People don't file for bankruptcy to stick it to their hospital, and their
hospital isn't putting 7 administrators and clerical workers per 10 physicians
on payroll to negotiate repayment and answer questions w/ people who could
easily pay their full bill. Let me clarify that I'm not siding w/ the
hospitals: you are getting screwed, there's no question about that.

My problem w/ the discourse here is people who treat this like some econ 101
practice problem, when there's no evidence that "price transparency" does
anything to address healthcare costs [1].

[1]: [https://www.nytimes.com/2016/12/19/upshot/price-
transparency...](https://www.nytimes.com/2016/12/19/upshot/price-transparency-
is-nice-just-dont-expect-it-to-cut-health-costs.html)

~~~
sumoboy
I don't know how often people are filing bankruptcy over hospital bills but I
don't it would matter even if there was price transparency. I haven't seen any
hospitals going bankrupt lately.

The cost of healthcare for those not under a group insurance plan or
subsidized ACA plans is crazy expensive for a family regardless. To the point
of what's more important your house payment or health ins payment? People are
just barely scraping by so the intent to pay in the bill in full is just a
dream, even if it's just a $100. They would rather face the consequences of
bill collectors nagging them which they just ignore.

~~~
almostdeadguy
I'm not arguing that there aren't people who are technically (but not
practically) capable of paying their hospital bills and don't, and for the
most part I don't disagree w/ any of the above (though medical debt has more
detrimental effects than just being "nagged", especially given there's a
documented effect of debt judgements creating a spiral of entanglements w/ the
criminal justice system [1]).

[1]: [https://www.aclu.org/issues/smart-justice/mass-
incarceration...](https://www.aclu.org/issues/smart-justice/mass-
incarceration/criminalization-private-debt)

------
sjg007
The real issue here is that HSAs are criminal.. Do not work for a company if
the only health insurance plan available is an HSA... unless you are young of
course.

------
pfisch
Procedures can't cost more than the average cost of the same procedure across
similar oecd countries.

We pop the corruption bubble and all fights about insurance costs would just
disappear because in reality the reason they are so high is because all of
this is just a shakedown from the medical/pharma industry.

I'm so sick of this all being framed as a battle over single/multi provider
obamacare insurance bullshit when it is really just misdirection and we are
being wildly overcharged for services.

It's like we can only debate whether we pay 1000% markup using a credit card,
paypal or cash, and not talk about the 1000% markup.

~~~
analog31
In my view, the only way to reduce the cost is to figure out where the money
is going. Otherwise, everybody can say: "We had to charge $58000 because we
had to pay someone else $57000." Right now everybody points to everybody else
as the culprit for high health care costs.

A centralized system has a better way of tracking this. If everybody involved
with the health care system is working for a government salary, and everybody
who sells equipment is selling it to the government, then we know who is
getting rich by exactly how much.

~~~
AnthonyMouse
> In my view, the only way to reduce the cost is to figure out where the money
> is going.

It isn't going to any specific place. The system is designed to destroy price
sensitivity, so everything is overpriced and everyone is charged for things
they don't actually need.

When there is a bill for $58000, it's not that the procedure costs $1000 and
there is this one place receiving the remaining balance we could just cut out.
It's that the procedure _would_ cost $1000 only everything that should have
cost $20 was charged for $200 and then 500% more steps were performed than
were necessary.

Trying to play the blame game is pointless because everyone will come up with
a reason to justify their high margin or unnecessary step and the truth is
nobody is innocent. What's needed is to actually make purchasing decisions
based on price. If one provider charges $58000 and the other charges $56000,
the patient should know _ahead of time_ that there is a $2000 price
difference, and actually pay the entire $2000 less by choosing the less
expensive one.

Do that and there is price competition, and the provider that does the work of
eliminating unnecessary costs for you will be the one with the lowest price.
And once you have someone offering to do a $1000 procedure for $1000, who is
going to pay $58000?

~~~
pfisch
Why should we have to figure this shit out for them at all!?

This procedure costs $x because it is the oecd average cost and that is the
end of the discussion. It is on them to fight over their slices of the pie
with each other. They don't get to make their problems our problems.

Its not realistic to act like people have time to price compare for emergency
medical services. It just isn't a normal free market so much as it is like a
mugging. When you get mugged the question is how much will you trade for your
life, and the answer is everything you have. We need to stop pretending like
it is a free market and trying to apply free market solutions that do not
apply.

~~~
AnthonyMouse
> This procedure costs $x because it is the oecd average cost and that is the
> end of the discussion. It is on them to fight over their slices of the pie
> with each other.

When their costs are lower than the OECD average then you're still paying too
much, but it's even worse when they're higher. Each country has different
regulations, taxes and subsidies, real estate costs, medical licensing rules
and supply of medical professionals, average income and cost of living which
affects how much workers have to be paid etc.

When the OECD average price for a procedure is $5000 but the zero-profit cost
of doing it in your country is $7000, nobody will do it. Or the provider who
already owns the equipment as a sunk cost will do it, but the waiting list for
the procedure will be 22 months. (Hopefully it's not related to an active
pregnancy.)

> Its not realistic to act like people have time to price compare for
> emergency medical services.

It's not realistic to act like all medical services are emergencies. Most of
them aren't, what's the excuse then?

And once you have a baseline for what a procedure costs in a competitive
market on a non-emergent basis in your location, it becomes a lot easier to
identify a 10,000% markup for no reason in an emergency situation as
manifestly unreasonable.

~~~
pfisch
The only way the profits could be 0 is if people's salaries are too high.

Vet school costs a lot, almost as much as medical school. Yet the procedures
are much, much cheaper. Probably because vets are paid half as much or less
than doctors.

~~~
AnthonyMouse
> The only way the profits could be 0 is if people's salaries are too high.

Salaries are supply and demand. If you lower salaries you get fewer doctors --
you have to convince people to go to medical school instead of law school or
business school.

And the OECD average salary may be too low if the relevant city has a higher
cost of living than the OECD average, requiring higher salaries to get people
to practice there rather than somewhere their money goes further.

------
bdodge4
Author of the article here: if anyone wants to talk more about their surprise
bills, shoot me an email at bdodge4@bloomberg.net

------
kleenme
Am I the only one who finds it strange to hear a doctor refer to a
hospital/practice as a "small business"?

------
nickthemagicman
Does any one else think that traditional capitalism 'supply and demand'
doesn't apply to medicine?

Because the demand for your life and health is infinite.

------
joecool1029
Here's a thought: Maybe doctors should do what nearly every other industry can
do. Provide a price quote upfront? I will say there was one circumstance where
I received upfront billing without health insurance and that was for a
colonoscopy. It was around $2k and they gave a 25% discount for payment
upfront. So it's certainly possible for healthcare providers to do this. As I
mention below, it's not usually the case:

I broke my hand a little over a year ago during a gap without health
insurance. Knowing the ER would start at $1000 for a 'hello' and that I might
not have a competent specialist, I decided to take matters into my own hands
(haha). First was a call to a friend in Montreal with a sister that's a
surgeon. I assessed that while driving to Canada would be more cost effective
than a US emergency room, the border might give me issues and followup visits
would be troublesome.

So, I walked off the mountain and made a makeshift splint at a Rite Aid with
medical tape and a plastic ruler for around $5 (
[https://twitter.com/vvtgd/status/879360595526635520](https://twitter.com/vvtgd/status/879360595526635520)
). When I got back home a few days later I went to a hand specialist, told
them I'd pay upfront and had them set it. All in with followups it was around
$800.

Initially the specialist's receptionist idiots couldn't figure out how to bill
me in person. If you have staff that doesn't know how to invoice a client that
pays in cash, you shouldn't be in business. Full stop. Why should a cash paid-
in-full client pay more than any other insurance company is beyond me.

Another back on insurance anecdote: I needed an urgent visit not too long ago.
PCP wasn't updated on my card, but I did it through health insurance website.
Dr still wouldn't accept. Had to pay in person with my CC. Receptionist stole
the CC details (it was the only place I used that card for magstripe
transaction at in weeks). I needed to get a new card and manually submit the
payment details. It's been two months and I still don't have the money back
for the visit.

(I'm not going to repeat myself but many years back I also had a rabies
vaccination story in which I received almost $20k in hospital bills)

What the above anecdote suggests is that the industry is broken and relies on
fantasyland pricing because providers no longer have to compete due to
insurance networks. The new hotness is VC's getting into running clinics
because as universities can do, they can charge unlimited pricing and force
the market to accept it. You don't have an option to barter with health
providers, you can't sue them when they are scumbags (because professional
protections, etc), and in most situations you don't have a choice whether you
get sick/injured... it's just the risk of living.

~~~
kwhitefoot
> colonoscopy. It was around $2k

What? It takes less than an hour and only two medical people (doctor doing the
dirty work and a nurse observing the patient and double checking the video)
plus a few minutes to finish the paperwork. The machinery involved is very
cheap nowadays and anyway lasts for many thousands of procedures. The
consumables are some lubricant, sterilising solutions, paper towels, and
something to clear your bowel the night before. At least that's basically what
it was like when I had one a few years ago in Norway.

How does that add up to two thousand dollars? Of course I don't know what mine
cost because I only had to pay about NOK 250 (very roughly USD 30).

