I was a victim of the surprise out of network bill in the Portland, OR area. I did all my research before hand: hospital in network, surgeon in network, etc. but ONE person in that operating room was not in network and SURPRISE i'm out thousands of dollars. The worst part about this is my state passed a bill to stop this prior to my surgery, but the bill's effective date was roughly 3 months later. Talk about bad timing.
I'm at a loss as to why the US is still dead set to have no meaningful health coverage.
I got burned by this in California a decade ago. A dentist charged me $4,500 to fix a broken tooth (panic!) and fill in a cavity on a Sunday.
Had I known then what it might have cost I'd have simply flown back to Europe in the next flight ($600-800 at the time) and get the same thing done for under $100-200 with a full refund from my local social security.
Adding insult to injury I had a very expensive international health insurance policy owing to my traveling around the world back then. And they didn't cover dental with my plan. I knew they wouldn't. But it was still mind boggling to me in that I never expected a casual procedure that would have cost me €150 at most anywhere in Europe - most of which would have gotten refunded at that - to cost me a whopping $4,500 in the US.
The health insurance industry spends millions in donations to politicians on both sides. So, the reason we have a poor health insurance industry is money.
There was a story about an Indian guy - he flew all the way from California, spent two weeks in India, took a bunch of MRI etc scans and went back. The entire of the trip, including airfare, hotel, scans etc was less than the cost of a scan in the U.S. Not sure how much of this is true (and yes, I do realize I shouldn't be comparing US with a developing country like India, cost wise), but it is definitely believable.
Given Theil's penchant for SnowCrash style Rafts, I'm surprised he hasn't parked an old oil tanker in international waters just off LA, retrofitted it for outpatient procedures and a helipad.
There is no political will to subsidize healthcare if the health costs themselves arent fixed
This second aspect has never been addressed on a national level, or barely at all.
At the state level, if you think of them as their own countries some do have very accessible programs. Some even having universal healthcare in that state.
So the US is complicated.
And then there is the distrust of how people of other cultures in our country would use a subsidy if it isnt clear that they have the same ethics and motives. This exacerbates many political issues.
>I'm at a loss as to why the US is still dead set to have no meaningful health coverage.
The US isn't a monolith. The majority of the population very much wants meaningful health coverage, but thanks to Supreme Court decisions like Citizens United, corporations are entitled to free political expression under the first Amendment, so they can give unlimited amounts of money to political candidates. This allows uberwealthy individuals to form corporations for the explicit purpose of installing anti-taxation cronies into legislatures at both the state and national level.
Our political process is very corrupt, and it's taken a national emergency (Trump's Presidency) to wake people up. The 2018 midterms demonstrated that far more citizens are paying attention and plan on voting, so hopefully the US goes single payer soon, but it's going to be a brutal political fight.
advertising is the biggest thing 'educating' voters, and usually it's usually something along the lines of here's why <party> <candidate> is bad, vote for me instead. News media is trash and unreliable as they too pander to advertisers or are just spewing nationally distributed talking points.
Bernie who was the most vocal about changes was taken out by Hillary, but no one batted an eye. No one really wants change to the healthcare and pharma industry as it will hurt the entire ecosystem (especially advertising $).
USA dentists don't work on Sunday. If you had waited until Monday you would have had many more options. Besides what could she have possibly done to "fix a broken tooth" in one day? Nobody was milling crowns in the office a decade ago. If it was really just a filling, wow.
Do dentists in Europe work on Sunday? In my experience the grocery stores aren't even open...
I've had emergency dental treatment in an NHS hospital in the UK for an extremely painful dental abscess - was treated first thing on a Sunday morning.
> I've had emergency dental treatment in an NHS hospital in the UK for an extremely painful dental abscess - was treated first thing on a Sunday morning.
Emergency dental care is provided in the US as well. Filling a cavity is not considered an emergency.
Very few oral problems are emergent. GP's abscess would have been visible on examination for months, and certainly was uncomfortable before it was extremely painful. In many cases the first treatment is a course of antibiotics, which any USA ER could administer perfectly well.
"certainly was uncomfortable before it was extremely painful"
Actually it wasn't - went from nothing to blinding pain as if someone threw a switch. I'd have 10-15 minutes of agony then it turned off for the same time and it repeated at that frequency all of the Saturday until a GP came out on the Saturday evening and gave me painkillers and told me to go to the emergency dental clinic the next day.
It was right in the middle of my 3 years exams at University - which was a bit of bad timing!
Hah, there's not a dentist in my entire County that works on Friday either. I've been in the situation where I've called each and every one, all closed Fri-Mon.
Even here in Norway, even on a Sunday it wouldn't have cost anywhere close to USD 4500. I have asked colleagues in the US about the cost of dentistry and most of it even when booked in advance is noticeably more expensive than here. But of course here we have full transparency, I can shop around.
Exact same thing happened to my friend. He did all his research, and while he was under anesthesia a nurse assisted that was out of network. $5k out of pocket. He ended up getting it removed after some run around between insurance and the hospital.
People misunderstand non-profits. There is nothing stopping you or I from starting a non-profit and soliciting donors then paying yourself a $1M salary.
Non-profit simply means any surplus of revenue is spent. So, the more revenue generated by a non-profit's paying customers means they get to funnel that to their core mission (likely research, possibly those that can't pay, or cynically more salary for those running the show).
Definitely not paid for with reimbursement revenues.
> amenities for staff
Try cutting these, and see how quickly 1199 SEIU comes down on you.
> raising administrator salaries "to retain premium talent", etc.
Even if you assumed that there were no relationship between the wages paid and the quality of work performed (there is), these are nowhere near big enough to account for the difference. They're also not that far out of line with other countries, either: 25% in the US, compared to 20% in the Netherlands, for example.
But more so than that: they're SG&A expenses, which are further down the balance sheet than the reimbursement revenues. And yet, hospitals actually lose money on the top line for Medicare patients (who represent about 40% of the market). That's the real reason reimbursement rates are raised for private insurers - the private insurers are required (by law) to pay more, and they need to subsidize the sub-COGS reimbursements from the public insurers (Medicare, and to a lesser extent Medicaid).
So no, none of the things you listed actually explain the reason hospitals charge private insurers the rates they do.
> No. That’s the justification given so that people get angry at the wrong thing. Hospitals charge this because they CAN. They are doing what businesses do and that is maximizing their profit.
Hospitals make very low profit margins; hospitals have been hemorrhaging money and either being bought out by hospital systems or insurers, or even shutting their doors entirely.
In any case, it's not uninsured patients that cost the hospital money; there aren't enough of them to make a difference at most hospitals. The patients that cost hospitals money are Medicare patients, because Medicare reimburses rates that are below COGS, and private insurers are required by law to reimburse more.
In other words, yes, it's the politicians that enable a broken system, but no, it's not the uninsured patients who are at fault, and it's not "profit-maximizing businesses" that are at fault either. Hospitals don't want this convoluted billing system any more than patients do, but it's literally forced on them as a result of accepting Medicare patients.
For this reason, I'm beginning to think that we do in fact have "universal" healthcare in that anyone can turn up to the hospital and be treated despite their income. For those who don't pay (or don't have insurance) the hospital spreads that cost out over their other patients and likely marks up the price to insure against non-payment. So we end up with an unregulated mess where any one hospital has to insure themselves (in the form of passing on costs) against the percentage of patients that will simply never pay.
Given that this is going on, why not just switch to a single payer system and spread this out over a much larger population rather than each hospital trying to insure against it?
We have universal care for emergency treatment, and only to the point of stabilization, and in a manner that basically combines all the worst aspects of various systems.
You can't get months worth of chemo or physical therapy or dermatological consults or whatnot at an ER.
This is actually only a half truth. Emergency rooms are required to treat patients who need emergency care. They don't need to fix all ailments. If you have cancer they can turn you away, but if your organs are failing as the result of cancer they have to treat you. If you need a heart surgery they can turn you away, but if you're having a heart attack they need to treat you. For the most part, treatment is pretty much just making sure you're stable and can leave the hospital without immediately dying. This only applies to emergency rooms as well. Where you go to get surgeries is usually not the same place you go to treat an emergency condition. It might be affiliated with the same hospital, and might be attached to the emergency room, but it isn't itself an emergency room.
Today is "don't believe the comments day" it seems. How is an unconscious person meant to be stop an "out of network" nurse assisting? Is there a tattoo that you can get?
> How is an unconscious person meant to be stop an "out of network" nurse assisting?
They can't. That's the problem - there's little you can do to stop it from happening, even if you're aware of this sort of billing problem and try to take steps to prevent it.
> Surprise bills occur when a patient goes to a hospital in his insurance network but receives treatment from a doctor who does not participate in the network, resulting in a direct bill to the patient. They can also occur in cases like Calver's, where insurers will pay for needed emergency care at the closest hospital — even if it is out of network — but the hospital and the insurer may not agree on a reasonable price. The hospital then demands that patients pay the difference, in a practice called balance billing.
> The surgeon's office later told her that he belonged to two different medical groups. One was in Morgan's husband's health plan network, the other wasn't.
> The surgeon's office later told her that he belonged to two different medical groups. One was in Morgan's husband's health plan network, the other wasn't.
I got this one, it was mindblowing. For ER work, they'd bill through one practice, for scheduled appointments, another.
I got balance billed for $11k. My father, who worked in employee benefits for over 30 years, couldn't even figure out what was up at first. Then they filed to send me to collections because I kept refusing to pay (note, I'm in California and this billing is illegal for life-threatening emergency visits matching the situation I was in). Finally, the insurance company stepped in and covered me, but we were only able to achieve this because my family knew people personally at the insurer.
With Medicaid (in New York, at least) a provider isn't allowed to bill a beneficiary for treatment. It is such a huge stress reliever. I can't figure out how so many people continually fall for the propaganda against single payer / Medicaid/care-for-all.
From what I understand (which is honestly not much), I think in cases like this you can contact the hospital and just insist on paying the same amount your insurance would have paid, and they'll often take it. That's just what I hear, though.
This is horrible advice. Do not agree to pay a penny of that fraudulent bill. If you didn't agree to the service, you should not be liable to pay.
Call the hospital and demand it be removed from your bill. That's what others[1] (including myself) have done and the fraudulent charge was eventually removed.
The absurd part is that you would even need to do this. How many people don't understand you can fight healthcare charges and get them removed? How many have the free time that it takes to call the billing department over and over?
The whole health insurance system is trash and needs to be replaced.
My last visit to a hospital it was requested I arrive 30 minutes early to "fill out paperwork". After arriving at the radiology department an office assistant took me into a nearby room and had me sign consent forms and make payment on the spot. Anxious for my exam I signed everything and handed over my debit card. Later on I realized one of the forms cemented acceptance of the debt and guaranteed my full payment of it. If I chose to I would have very little ground to stand on disputing the costs ($800 for an ultrasound).
Hospitals are for-profit entities that will optimize debt-collection and bargaining power over patients. They will start taking payment upfront as well as influencing patients to choose financing options that are in the best interest of the hospital and not the patient themselves.
It's hard not to feel like the whole system is rotten.
Yes it is, there are several factors jacking up the price in the US. There are some good videos on it on Youtube. I was always wondering why people think that it is a free market there. In Europe there are several countries that let you use private and public health insurance (even at the same time) and you can go to any healthcare provider and still get a reasonable price. In my country the private provider "industry" is booming and most lab work can be done in a private manner, usually for a very reasonable price. Most of this is accessible in a week ahead booking time.
Regardless of insurance, when you offer to pay cash hospitals will often slash the price considerably. If the hospital has to use a debt collection agency, then they're looking at getting a small fraction of the list price back - sometimes an order of magnitude less. They're willing to negotiate accordingly.
Not in all cases - it varies significantly for everyone. In my case the hospital, surgeon, anesthesiologist, and some of the assistants were all billed under different systems and as separate entities. The hospital has nothing to negotiate because they're in-network so I had no balance due (meet my out of pocket maximum).
The surgeon's assistant was the out of network provider and he was also part of a different practice, so it was his practice billing department that would not budge because they deemed their costs as reasonable and "already discounted".
Yes, moonlighters (the surgeon in that room) are expensive (to both you and the hospital). Why do you think that person wound up there?
Otherwise underpaid, overworked surgical residents leave either due to truly catastrophic burnout, mental illness, family emergency or pregnancy.
They are replaced by moonlighters, because the economics of the surgery are that the nurses and other unionized employees get mandatory breaks, so the seemingly 1-2 hour delay waiting for a different resident to be free balloons into a multi-staff scheduling fiasco. We could amortize all those costs into "surgery minutes" which are paid whether or not the literal room is in use or whatever.
It's a math problem if by saving surgery minutes, the hospital saves real economic money for itself, the patient or the state, so I'm not sure if that is or is not the case in your particular case.
What's interesting isn't that there's legislation one way or another, or that you feel like you got a raw deal. The legislation isn't going to change what it says it will, because it will still make sense to hire moonlighters. And motivated people like you will still somehow still wind up paying the cost.
The real test of your merit is whether or not you think in the grand scheme of things, this is fair. Are you frustrated that there may have been a pregnant resident, and that's why there's a moonlighter in the operating room?
What does justice look like there? Cut you a check for thousands of dollars? That never happens. Retribution on residents who might get pregnant? That's what happens.
Your situation is shitty. I know in most movies, books and the press, the doctor is usually the antagonist. We live in a world that resents their disproportionately immigrant backgrounds, disproportionately even gender balance compared to other professions, and most of all their pay, despite their hard work. How do you feel?
Except I highly doubt the staff and doctors are actually being paid in proportion to the charge. I doubt they’re even being paid a significant portion of that bill. We’re not hurting doctors and nurses when people claim to want more efficient healthcare strategies. There are ways to allow moonlighting, such as everyone being in-network to a greater social healthcare system.
Even out of network, you are able to bill your insurance directly. There are a lot of private practices not in network with any providers at all where insurance will still cover, you just have to do the legwork yourself usually.
Appealed twice and both times they denied it stating I didn't require the surgery despite the fact they pre-approved it and paid for all the in-network costs. I ended up paying it because I had the money and I couldn't handle the stress of a legal battle (which given what I've read is an uphill battle).
Sorry to hear that.. you can usually appeal up the food chain sometimes.. e.g. to your states insurance department if the plan is regulated by your state. And at the Federal level you can also submit a ERISA appeal. None of it is fun and then there are deadlines... Also if you are on an employer provided insurance plan, you can talk to your HR who will have an insurance rep who can sometimes make these things go away e.g. get them paid. If you are at a large employer that self insures and uses a third party admin (like Cigna) then they can tell the admin to negotiate with the doctor/hospital and pay it.
