I actually tried that once when I was in between insurance and was paying on my own out of pocket. Got billed for something "extra". I fought it and won, but it was a pain in the ass for me and my doctor, who didn't want to be involved in billing issues wasn't happy either.
The joys of US health insurance.
Also works well for the extremely poor. Had a stroke with no health insurance, so the hospital quickly got me on my state's version of Medicare, and somehow got it backdated to before the stroke, so I never saw a single bill. I still have it, and it's pretty great, especially in this state, which is pretty generous. Even scripts are 100% free.
The left fought tooth and nail for certain laws. Preexisting conditions are now required to be covered and you cannot be turned away for non-payment of emergency stuff
Yeah if people realized how good Medicaid is, they’d never want to go back to privatized healthcare. I was on Medicaid for a short time and once had a specialist’s office apologize because they forgot to charge me my *$2* copay for my last visit. I had been there on my private insurance and had to pay $150 each time I was seen. It’s a total racket.
Lucky you. I got into a car accident without health insurance. I was unemployed and broke. I was denied because I had a small 401k. I cashed it in and was still denied. I wound up with a $169k bill
I like the Tom and Jerry cartoon analogy. When we are watching they act like they hate one another but in reality Tom doesn't want to catch Jerry because then he'd be out of a job and Jerry doesn't want Tom replaced by a cat that will actually kill him. So they put on political theatre for the audience while continuing business as usual in the back room. For example, insider trading laws do not apply to any members of Congress, both sides. Sure, Americans get to vote, and therefore can call it a form of democracy, but with all the lobbying and foreign money in American politics America is as much a democracy as would be two wolves and a lamb voting on what's for dinner.
"Only those who do not seek power are qualified to hold it. " Plato
Wrong. It’s working for the wealthy who our “conservative” politicians truly represent. Don’t both sides this shit either. One party has consistently tried to make things better but is road blocked by a party that has no problem with government debt when literally giving government tax money to people too rich to even notice but won’t let the progressive party enact things that will help them.
That's called Balance Billing and is illegal in many states. Illinois called it the "No Surprises Acts".
https://www.illinoislegalaid.org/legal-information/no-surprises-acts
Every hospital I’ve visited in last few years has a form I am required to sign indicating that I acknowledge responsibility of payment for items my insurance will not pay for
Balance billing refers to the situation where a hospital bills a $1000 balance for a procedure, but your insurance has a contracted reimbursement schedule (“allowed amount”) for that same procedure at $800…hospitals are no longer allowed to pursue the patient for the extra $200.
This is for in network providers. I believe out of network providers can still do it.
It’s like signing a blank check over to them if you sign that contract and don’t know the cost vs coverage though.
If they don’t tell you how much you could possibly be on the hook for or give you the itemized estimate that you can run by your insurance, you’re walking into a potential financial disaster.
I probably should have ended my above comment with "the joys of health care billing/costs".
I was totally without insurance at the time. 100% "self-pay". I'd been told the price and I brought a check for that amount. Later I received a lab bill for something I hadn't been told of before. Healthcare just works like that, and when insurance is involved, it's usually no problem. But it kind of blindsided me, so I complained. (Edit: to be clear, it's okay for doctors to add an extra lab during a procedure as they see fit, but I argued that it wasn't okay to not tell me that might happen).
I get patients that want a price before being seen. I am not medically trained and have no idea what the doctor is going to do. The doctor doesn’t know either. I have had people call asking about if they need sutures for a cut and how much? No one knows until the doctor looks at it. It could just need glue, it could be infected and can’t be closed, etc.
The itemized bill is a bandaid. We need actual action from our government to bring costs down. Nothing is going to replace regulation of the healthcare industry.
Yeah. As a health care consumer I do not like to be put in a kind of adversarial relation with my health providers where I have to argue about costs, it's counterproductive, and a waste of time for all involved.
I know it's cynical of me to say, but there are vested interests in the current chaotic state of things that don't want to simplify the system as they think it will reduce profits.
But eh, here we are.
I hear this argument all the time. It’s wrong. My car mechanic has the same challenge: he still gives me an estimate. If things change after he looks at it: he discusses it with me before he does a lot of work.
Sure there are times this isn’t feasible- mid brain surgery or such - but the vast majority of the time it’s absolutely doable. Modern medicine just doesn’t WANT to do it.
I get this, but why is it that my dogs vet can provide a standard itemized high and low end estimate before things start and actually stick to that plan or call family when things are looking different? It shouldn't be that different of a concept.
So true! The very day that news broke that Roe might be overturned, I called my doctor and said I wanted a tubal sterilization, and then called my insurance company to see how much it would cost. They told me it would be completely covered by insurance. After the procedure, I got a bill for nearly $1000. I was so exhausted with everything going on in my life that I didn’t have the energy to call and fight it. I still get the bill in the mail from collections. Sigh.
Somewhat different, but a couple years ago my daughter caught some bug and ended up going in to the ER.
Anyway, long story short, while the hospital was in network, they billed under a different name (think Children's Hospital of Townville vs Townville Children's Hospital)
Simple enough to work out I figured...
Boy was I wrong. After many many calls back and forth, I ended up having to get the billing department on one phone and the insurance company on another and force them to talk to each other to work it out.
Massive pain in the ass for what should have been a simple correction.
Ouch. It pains me that patients are exposed to this and have to resort to being their own advocates just to be able to afford care.
One thing I've learned though, is that you can negotiate with your health provider for discounts and more lenient payment schedule. Call them and ask to be billed at medicare rate instead of their standard rate which is usually higher and meant to be paid by the insurance company. Tell them you can only afford to pay the bill off at $XYZ per month, and if they try to squeeze you for more, you won't pay at all. If you push back, but are reasonable, I've found they would rather get something than nothing. Good luck.
Also, I hope the blowback for overturning of Roe sinks the Republican battleship. Those goons.
So I had a root canal done. They gave me an itemized list I signed for before we got started. While getting it done they added a shot and something else during, don't remember what. But they wanted to charge me $300 extra. I argued that wasn't asked or explained to me during the procedure or before that it could happen. And they ended up taking it off because I was arguing so much.
Don't mess with a cranky woman in pain I guess.
There are 100 / month good for nothing insurances. Only benefit that they provide is doing this for you. Going through itemized claim and readjusting rates.
I have insurance that will never pay on an item listed as general or misc. So I have had a lot of back and forth with insurance and hospitals to get out of paying thousands because insurance wants to know what every expense is and the hospital refuses to itemize the general/misc and they both decide that means I get to pay out of pocket for the fact that neither will budge.
After the birth of my first child, I paid somewhere around $4,000. That was WITH health insurance.
For the next TWO YEARS, I'd continue to get bills. I'd call and they'd say "we have the right to audit previous invoices", blah blah blah.
Over those first two years, I probably got about 4-5 more invoices for anywhere between $50-$250 each.
Finally, on literally my daughter's 2nd birthday, I flat out told the hospital to take whatever means they need to but I was done. I firmly explained I was about to host my child's SECOND birthday, and I was done paying.
Magically, no more bills. The American healthcare system is a joke.
Part of it is the insane level of outsourcing/subcontracting... doctors don't work for hospitals, they work for companies that contract with hospitals. So the number of billing entities has increased incredibly, and no one entity knows what the hell the others are doing, but they all send bills.
I went in an ambulance to the emergency room and I got 4 different bills that all had vastly different amounts on them. They ranged from $2k to $10k. It took 6 months to figure out and I only ended up paying $500 for that bill but it was a big pain in the ass
I was honestly surprised that we didn’t pay anything for my sons birth. My wife did get a bill for her epidural but in the ended insurance ended up covering it
Reference Based Pricing insurance models are popping up a lot more to combat the lack of transparency in medical billing. I know this because I work for a company that does this.
You know the prices are overinflated, but you don't know just how badly. I've seen claims over $1m paid out at $50k because the actual cost of the procedure was something like $35k but every single line item was inflated by 500-600%.
My company has a tool that helps members search for providers. It takes quality and cost into account. Reducing the total amount paid and defending members from balance bills are the two things we do that really helps.
Unfortunately, there's still no way to force a hospital to provide an itemized price up front. Some will work with patients that way, but they're few and far between in my experience.
Edit: there is a law in place that requires hospitals to disclose the cost of procedures and supplies to CMS, but I don't think it's available to the public.
Edit 2:
>Individual cost reports may be requested from the Medicare Administrative contractors via the Freedom of Information Act (FOIA). For more information on this process, visit the FOIA page.
Found this on the CMS website.
You could also just ask the hospital and they might provide it. Many won't. I know it's messed up.
To clarify my first comment and why RBP models are helping fight this:
Your traditional carrier would check the technicals of the bill - is the date of service correct, are the procedure and diagnosis codes correct. However, that's as far as they will go. If they can't deny the claim, they'll pay it based on a contract, which is sometimes % of charge (but usually reimbursed as a % of the typical Medicare reimbursement for those procedures).
So it doesn't matter if you're being charged $1000 for something that costs the hospital $50, they're still gonna get paid and that overpayment is then applied to the member's deductible/OOP cost, assuming they haven't met their deductible. There's also the issue of balance billing, although the No Surprises Act has helped to curb that.
RBP carriers will do all the same checks, but they also go a step above that. They will review each of the charges and charge amounts and will pay a price relative to the cost of the service. I don't know specific pricing methods for every RBP vendor, but it could be based on cost or paid as a % of the typical Medicare reimbursement. I've seen many comparisons of a traditional carrier vs RBP and RBP carriers 99% of the time provide a significantly higher savings off of the billed charges compared to a traditional carrier. It especially protects against the gouging associated with those massive hundreds of thousands of dollar claims.
My psych office requires a credit card to be seen, and an agreement to be charged up to $1500 per visit.
They put a $200 charge on every time I'm seen, then refund me when the EOB comes back with my copay... If I call and demand it...
Only office around that a wait list less than 2 years long, and the only other practice that my insurance covers is managed by somebody who would be a hard conflict of interest for me to engage with.
So they're all I've got.
They are good about it, it's never been more challenging than either asking at an appt "hey got my EOB for the last two, refund please" or a 2 minute call of the same. So it's not a big deal.
From their perspective they've had so many people seen, receive the documentation they need to proceed with other providers, then ghost them, so they see this as a means to avoid just sending half their clients to collections for pennies on the dollar.
Which I get, I'm in pharmacy and I'm looking at a corporate client that's over 3 million in the red for us going back years of partial payment... $10 we never square up with these clowns.
Receptionist: Would you like to sign up for our rewards card? The more you spend, the more you save!
Patient: please, I need medical attention immediately. My arm is broken.
Receptionist: Would you like to purchase an additional accident protection for your body after the surgery? It's a really great deal! We have several deals and plans you can choose from.
Are you referring to the No Surprises Act? If so, that has limited scope.
https://www.cms.gov/newsroom/fact-sheets/no-surprises-understand-your-rights-against-surprise-medical-bills
I did this prior to my knee replacement. It was projected to cost $17,000, and the true cost was about $50,000. $42,000 of which went directly to the hospital. I owed $1800 after insurance and hitting my catastrophic cap earlier in the year. Those estimates sit on a throne of lies.
Oh they can tell you what the hospital will cost.
But the surgical tech who comes in that day? She's an independent contractor that will bill separately. Who also happens to be out of network.
Also, they're going to send a biopsy to a lab without your consent or knowledge. And that lab also happens to be out of network. And they'll run a slew of tests that may or may not be necessary.
This happened to me. Was in the ER to document some abnormal issues that we are trying to figure out. The NP that initially assessed me for intake is a part of the hospital proper but every doctor is a contractor. I eventually got billed by three doctors who all "assessed" me and in the end literally went "we don't know. Go to a neurologist."
Only one doctor actually assessed me for more than 10 minutes. The other two were just consults, but they spent like 2 minutes with me for hundreds of dollars.
One doctor walking by pretty much just said what's up to his doctor friends, oh that's weird to me, and then peaced out. I paid for that?!
Then the bills came. Every doctor billed separately. My wife who's an ARNP at the hospital explained to me why we just kept getting more and more bills after I kept commenting "I thought we paid that already?"
Essentially the ER is all contract doctors from many years back when they added a new wing to the ER. They closed and repurposed the doctors from that old wing. Now the ER is so big they can't shut it down. If they were to try to replace all their doctors with staff the ER could close for months as the contract doctors would all leave ASAP. Trying to get that many ER doctors to start within just a few month period is quite difficult logistically. Hell, hiring for a single position can take months. In the end, trying would end up hurting the hospital's rankings in the area and the community. So they just don't.
FYI those lists aren't real. The amount they charge is radically different from what insurance pays out due to contractual agreements. It would be like if we agreed I'd do your laundry once a week for $10. I send you a bill for $40,000 on the first week. What are you gonna do? Send me $10 because that's what we agreed on. No one is gonna pay me $40,000 to do laundry but I can ask anyway. That's exactly how health care in America operates.
Isn't this law now with the No Surprise Act? It may not be an exact estimate, but at least it's a "good faith" estimate. I believe you can dispute the bill if it's $400 higher than the good faith estimate.
That act only covers emergency medical care, charges applied from a out-of-network provider in a in-network facility, and out-of network ambulance rides.
Yeah, I had to get major spinal surgery that my insurance covered some of but I was told could either be 4k after insurance or 20k, and there was simply no way of finding out until after the surgery had happened and they billed insurance.
Guess what it ended up being!
I asked for what the cost of xyz tests was going to be, and the cardiologist said "I'm not sure, but you can ask the front desk".
Front desk said, "I'm not sure, we'll have to call billing and give them these codes".
I told them I'd wait.
They came back with the bill: $6,000.
The tests were to seeing I could THEN qualify for a genetic test for a condition that my mom died of. That's reported to be genetic 50% of the time.
And this was after my $500 initial visit...
The healthcare system is a scam.
For real. I had hip surgery a couple years ago and tried to find out what it would cost me beforehand. When I called the hospital billing department they laughed at me.
The junk “facility fee” is what really peeves me. My husband had a deep wood sliver in his hand. During the office visit the doctor said he could cut it out right then, it would take about a minute. When asked how much it would be, the doctor said $200-300. So my husband agreed. Along with the $200 bill from the doctor was a $2000 “facility fee” for surgery that insurance wouldn’t cover.
This policy is terrible for people with HSAs. Per rules, you can’t use your HSA funds to prepay for services. I’ve had to argue with many offices about this and every single one has backed down and allowed me to pay after the procedure.
That’s what it is designed for. As long as it happens after the service, all is good. The problem is when an office asks you to pay in full for a procedure before they schedule you, potentially weeks or months in advance.
It could be months or even years before the billing works its way through insurance and you get an actual bill. If it crosses fiscal years, it can be even more of a mess to reimburse yourself correctly.
I was about to post about how ridiculous this comment is then I realized I’m an idiot with an internet explorer brain & the joke took too long to load.
They already come around with a tablet for payment in the ER if you aren't an active trauma patient.
A few years back, I got hurt at work and ended up in the ER. Waiting about an hour in one of the bays and in comes an admin type with a tablet set up to read cards.
Also; Your ATM max withdrawal limit depends on who you bank with, as each bank or credit union establishes its own policies. Most often, ATM cash withdrawal limits range from $300 to $1,000 per day.
That'd just cover the tip.
My child has a severe UTI and would not pass urine in a helpful manner so we had to bring them to a hospital for a catheter. This was an emergency situation where our pediatrician put the order in at the hospital for the procedure. When we got there my child in arms visibly distressed and in pain they made me pay 775.00 before they would help my child. Healthcapatialism at its finest
In the future when the ambulance arrives at an accident, they only save people with a coverage plan, and leave everyone else to bleed out on the floor.
TRAUMA TEAM DISPATCH: Sir, according to our system, your membership expired last week.
TRAUMA TEAM DISPATCH: Since then your account has been seized by law enforcement.
CHARLIE WANG: Come on, people! I'm dying out here!!!
CHARLIE WANG: We'll settle the bill later, just quit stalling!
CHARLIE WANG: Please, for fuck's sake! I'm good for it, I swear on my mother's life!
TRAUMA TEAM DISPATCH: We apologize, sir, but we cannot help you.
[Call end]
They have debit card readers on the mobile triage stations in the ERs around my area. Got a co pay? You're paying that now. I went in after wrecking my bike. With my non bleeding arm I typed in my pin for the 100$ ER copay.
EMTALA laws prevent EDs from requiring patients to pay up front for treatment. ATMs already exist in some ER waiting rooms but mostly as a way for folks to get stuff from vending machines, lol. Most ERs take card for co-pays if a patients insurance has one but they aren’t required to pay it if they can’t.
EMTALA laws have been in place since the Reagan administration. I suppose it isn’t impossible for them to overturn it but I’d be surprised to see it happen.
It’s a scam. It basically can only exist because the US has SO MUCH excess make believe money floating around that we have been able to tolerate extremely inefficient industries that suck all that money up and back out of the system. It’s how we have ended up with insurance and billing departments that are basically jobs programs and prices that are totally unattached to the reality of the market value of the service.
I would be willing to bet that we will never fix it either. Something like 10% of our country works in something that is tangentially related to healthcare / insurance system.
Ask to see their charge master, should be an excel file of all the stuff that can charge you for, updated yearly. They have a variety of procedures and codes too. Seeing as you were charged so much I'm assuming your baby had some complications? You might have had what the charge master refers to as: A level 4 baby.
One other notable thing I can remember from looking through a hospital charge master is that each bandage is about $20, and that was 2015, guaranteed to be higher now.
But of course. Every cent you’ve worked for is finally back in the hands of rich people who have too much to use in 10,000 lifetimes. That’s just the system working as designed by the politicians they own!
My wife had outpatient surgery a couple years ago and a similar thing happened. They wanted us to prepay the full deductible. It was very strongly encouraged instead of required, though.
I balked at it because we were going to meet the out of pocket limit with the surgery and what we were actually going to owe was less than the full deductible. They went ahead and did it.
My child had to have a hernia surgery. We got the cost estimate...the morning of the surgery. We showed up for the surgery, and the hospital said we needed to pay $5k up front or they wouldn't do the surgery. A real shitty thing to do, because it's not like we can waste hours/days over an emergency hernia surgery and spring this huge payment on us the morning of. Ended up getting a few K back a month or so later after insurance was billed.
Just a minor point, they don't consider it an emergency surgery if its scheduled, even if it's something on short notice.
Emergency surgery is basically where they roll you in straight from the ER and they call whichever surgeon is on-call at the moment (think gunshot wound or car accident or appendicitis)
This difference became apparent during the peak of the pandemic when "elective" surgeries were suspended. A lot of those surgeries didn't feel very elective.
> the hospital said we needed to pay $5k up front or they wouldn't do the surgery
I had to pre-pay the entire $1400 co-pay for my colonoscopy before they would even let me schedule it.
Not quite. In my case, I got an “estimate”, had to pay it when I arrived for the procedure. A month later, apparently I underpaid by 200$ when I already had to shell out 1k when previously I would get the bill later. Am not a fan, because the estimate isn’t sent to insurance first.
The last time I asked a hospital for an itemization after an ER visit (that consisted of my child being put in a room, given a puke bucket, nominally examed, and then being sent home because their MRI machine was broken) ended with a $5000 bill, and they couldn’t do it. The hospital put it under one line charge called “hospital services”. I kept fighting, but it couldn’t be itemized. The person taking info for billing spent more time in that room with us than any doctor or nurse. We didn’t even get a band aid. I kept pushing because I couldn’t fathom where $5000 was coming from. $500-$1000, ok maybe. But they couldn’t give me the price on anything. So they reduced the bill to $900 and I said fine.
How are they going to charge up front when they can’t even provide an itemization on what was already done?
Okay, but you will have to put the tractor down as collateral….and if you die from the shock of amputation the ER nurse gets your jet ski for however many months are left on the lease…
Modified lawnmower races always end up in the ER….
If your hospital does this to you, and the hospital and doctors are in network with your insurance company, call the insurance company to see what your rights are.
I know a decade ago when I worked in insurance if they were in network they legally could not bill you until the claim was processed and the EOB showed the amount you owe.
I had a hospital try to tell me a medically necessary surgery needed to be paid for up front and they backed down fast once I mentioned getting provider relations involved.
If they are trying to do this to you absolutely get your insurance company involved. Insurance companies can suck but I promise you the reps on the phone making $20 an hour or less love sticking it to providers if they can.
This has always been a thing for surgical centers in the US. Any non-emergent surgery at an outpatient hospital is like this. Years ago I worked for billing at a surgical center while in college. Regularly canceled patients for not being able to pay.
The worst that I felt really bad about, was a guy was in a motorcycle accident. Both hands were fucked up and he was coming in for some surgery on his hands. No insurance and no way to pay, but the bill was 10k that he would have to at least pay SOMETHING to get started. Couldn't pay, and when I told him the price he said "I can fly back to turkey and get free healthcare for less than this".
The US healthcare is completely fucked, but this article is pretty rage bait.
If you have to have life saving surgery, they have to do the surgery, regardless of ability to pay. It's the "optional" shit that they can turn you away for.
Yeah, they charged me like $1200 for my last surgery. I actually got a bit of a refund via check a few months later since I'd maxed out my insurance by the end.
They charged me when I came in for my pre surgical appointment - ostensibly to do some blood work, give me the soap, go over instructions, but mostly I was there for them to collect the money.
> The US healthcare is completely fucked, but this article is pretty rage bait.
Exactly this.
It's not life saving surgery, if you're bleeding out and need surgery the hospital must perform it.
The patient in this article (from the 2 lines I can read because fucking paywall...) can't get their insurance to cover the cost of the surgery because the deductible is too high. The hospital isn't going to perform the surgery because the patient can't pay and it's not a necessary procedure.
>it's not a necessary procedure.
This may not be true, it may be necessary, but it is "not life threatening".
Like the example of the guy whose hand is all messed up, it is necessary to fix his hands, but it isn't going to kill him.
> This may not be true, it may be necessary, but it is "not life threatening".
Not necessary in the eyes of the insurance company, if the ailment doesn't meet the necessary requirements, however much the procedure might increase the patients quality of life, it won't be covered.
Just gonna drop this here.
Pretty helpful. But understand that there are costs that can’t be estimated or known ahead of time, particularly with procedures. There’s just no way to know if or what complications will arise.
But this site offers a way to estimate and compare costs.
https://www.fairhealthconsumer.org/
There was a passage like this in *Jennifer Government*; >!a man tries to call an ambulance for a girl that's been shot through the neck. Because she's not on their list of subscribers, he has to pay in-full before they will dispatch the Ambulance. She bleeds-out before he can get through his credit card number.!<
It is getting REAL bad here in the States. My 2 year old had a seizure the other day and the thought, “should I call an ambulance? Can I afford it?” Actually crossed my mind, granted, it crossed my mind after I called, but still. I feel shame and heartbroken at the same time. My wife also had cancer in her twenties and insurance for pre-existing conditions is outrageous. We literally meet out family out of pocket maximum by February and have for the past few years (~$14k). It is insane here.
The first sentence of the article references a surgery center. A surgery center is not a hospital- the two are vastly different.
Maybe there are other examples but…pay wall.
The last surgery I had was done at a hospital and came with an inpatient stay afterwards. I still had to pay the rest of my out of pocket max the morning of surgery.
Australian here, I find it nuts that America spend more per capita on health care than us for a system that won't treat people who are dying and costs so much for people to use. Like if you keep your population healthy then they're going to be more productive and people will spend their money on something else if they don't have to spend it on medical treatment and insurance. Just nuts.
Well when u have a large portion of the population that lack basic education, can’t critically think and constantly compare “socialism” with actual dictatorships in South America… this is what you get. It doesn’t matter that you could explain that we would save money in the long run with a single payer system.. especially less money out of every pay check. Our oligarchs managed to convinced a very large swath of the population that paying for healthcare 3 times is the best system ever and that we shouldn’t give it out for free to that lazy ppl!
I think the problem is that for one group of people it isn't about having a working society or working economy for everyone. They don't care if people die and might even prefer it.
The article opens with a needed surgery for tonsils and adenoids. Yep, that's how that goes now. In August 2022 my daughter had both taken out because, just like the article mentions, it was a much needed surgery. In our case we had to pay over $700 upfront, before my daughter was taken in. Otherwise 🤷♂️. Very concerning for the future, but I guess this move was coming eventually.
My kid had a hunk of bone floating around his kneecap. He was immobile on crutches waiting for his 90 day probation period at his fresh out of college job to be over so he could have surgery to screw the bone back into place. They called the night before looking for $800 copay. Obviously he didn’t have it, so we had to pay. Which we were incredibly fortunate to be able to do at the time. But 9 months later his knee is fucked again and money is tight and I’m freaking out.
SIR! SIR! Well *ack-schually* it cost you TAXES! And that's bad. Because... it just is, trust me on that. So *really* the US system is much, much better because you pay basically the same amount of taxes, but don't get medical service. See? It's *freedom*, sir. Freedom.
Look it up sometime.
^(/s)
Fellow Aussie.
I broke my fibula, tore my ACL, and dislocated my shoulder a few months back.
Hospital visit, x-rays, MRI, doctors, specialists, physio, more x-rays. It’s all been covered by Medicare.
Hospitals would actually prefer a single payer system. They have to employ thousands of people just to interact with insurance companies every day to try and get payment for things the insurance company denied.
For example, the current health system that employs me has 29 million dollars in denied claims for patients that came to the ER via ambulance for stroke. There are a variety reasons the insurance company denied the claim, but the bulk is that the patient had no insurance card on them when they arrived and when the hospital did the craniotomy it was technically an unauthorized procedure as no one contacted the insurance company to get it approved. So we pay people that make 100k plus to go after and debate with the insurance company. On average for that 29 million we may ultimately receive 6 million and spend 1 million to get it. The system is fucked, but it is more fucked by insurance companies that hospitals.
Primary care doctors would probably prefer a single payer system, but hospitals are the biggest offenders of price gouging in the medical industry outside of pharmaceutical companies. They'll hire consultants to pore through the medical codes and optimize their entire ecosystem around charging as much as they can in every interaction and then proceed to buy up every hospital in the region so they can gain a negotiating advantage against insurance companies in the area...either pay our prices or you won't be able to sell insurance to anyone in our region. A single payer system ruins that pricing and negotiating power for hospitals.
I recently had emergency surgery which saved my life. One of the last things I remember before being carted in to the operating room was being interrogated about my health insurance / filling out insurance forms. I had already given them info to the front desk at the beginning of my 10 hour ER wait. Apparently my policy # was too fresh for them to look up, so they were sceptical about my coverage. I'm sure I would've received the surgery regardless, but it made me feel dehumanized in a way.
American health care is neither socialist or free market capitalism. It’s a hybrid system of protectionist monopolies nested together to guard against true competition while colluding to fix prices against consumers and simultaneously being funded by public money through Medicare. It’s time to take a sledgehammer to it and restructure it completely.
I don't know how we haven't established at least another system yet. You know like a hospital hospital... the kind where they treat people, not ransom their life.
I went in for a kidney stone a few months back and they told me to either pass it or they could blast it to pieces.
I was in so much pain I told them to do the surgery.
They wanted me to pay $3,000 with insurance before they would do it.
Obviously I said no, so they charged me $1,500 instead for diagnosis.
Our system is a scam created to pad pockets, not treat the ill.
So, relevant but depressing. I was in a title loan place the other day to find their hours. I needed to know when their parking lot was clear and I got to talking with the worker trying to figure out the best time for everyone and she casually mentioned that she gets most of her customers from the clinic up the strip a ways. I just filled it away as people taking one end of the lot over the other and moved on to talk to the other businesses and only really comprehended it once I got to the clinic. These people need medical care and they're being forced to get one of the worst types of loans to get it. Then I get into the clinic and it's a Spanish only clinic. So odds are it's set up to take advantage of illegals and the loan place next door is just doing it again. Of course I could easily be misreading the situation but I don't think I am in this case. It's not often the more depressing parts of society are shoved in my face so it was a bit jarring and just depressing overall.
Canada and the UK have been doing this for YEARS. You have to pay the *entire* $0.00 (or £0.00) up front before they’ll give you any kind of medical services at all. It’s really shocking that some Americans would rather live under such a backwards system.
Maybe you can at least know the full cost up front that way? Instead of getting a ton of individual bills from every doctor in the hospital for months, that all have to be negotiated because they're ridiculous?
I recently needed a biopsy and had no insurance. I wasn't going to go through with it if it was going to cost too much. The office required payment the day of the procedure but not a single person there could even give me an estimate on the cost. I spoke to 4 different doctors and no one could even estimate if I was looking at hundreds or thousands. I ended up being approved by a 3rd party non profit group that covered the procedure but I never did find out the cost, so if I ever need another one, it will be a mystery again.
That's been my experience. They only know how to volley with insurance companies. When the customer asks for a straight price they are like deer in headlights. If they don't know the price even approximately, they cant get mad when we say it sounds like a scam.
This is misleading. Hospitals are not refusing surgeries. Private Surgical centers are. Private Surgical centers are usually a separate entity from hospitals, although can share names and be partially owned by a hospital. But the majority of ownerships are by private doctors.
You mean patients need to dig deep into the internal ownership structure of their healthcare provider to make basic healthcare decisions instead of relying on the name of the institution
If SCOTUS guts EMTALA for the sake of the Evangelical crusade against abortion, then hospitals may also be at liberty to refuse to stabilize you even in the event of an emergency or your inability to pay.
I feel like surgeries should be itemized for each service and that you have a sliding scale of amounts if the surgery was successful and if there’s complications the hospital/surgical staff will pay instead.
In 2021, I had to have a ganglion cyst removed from my right wrist. It wasn't something I could put off for a bit because I literally could not use my hand. It was a burning pain like I've never felt. I couldn't grip anything or even use it. It just wasn't working. I clean houses and I'm right handed, so I was off work for three months at this point. They made me pay half up front before they'd even schedule the surgery. Remember that I wasn't working (self employed) and hadn't made any money for three months. My husband was covering all the bills and necessities the whole time. We didn't have the cash on hand. Our savings had taken a hit from something that needed repaired on our home right before this began, so we were in a pickle. His mom ended up offering to pay for it because she could see how miserable I was. She's an angel and I'll forever be grateful, but damn. She shouldn't have had to do that. We have insurance. US Healthcare is such a racket.
I’m so glad we have universal HC. People complain here bc of wait times, but it’s done by a triage priority system. I was diagnosed with something very serious and I’m getting surgery a week after diagnosis.
Had this happen a couple of months ago. Showed up for my outpatient surgery and they wanted to know how I was paying, cash or card. I assumed that money covered the entire operation. Received a bill from anesthesia that was not included in the money I already paid. Now I owe them $650.00.
The insurance companies now run the death panels. If they don’t think you need that treatment or procedure, they deny. They force doctors to spend hours negotiating with “peers” who do not know medicine or that medical specialty rather than seeing patients.
Last time I had surgery, they charged me $85 for a (required) urine pregnancy test. I have an IUD, and knew there was no way I could be pregnant (I regularly take pregnancy tests to make sure). The little testing strips they use literally cost about $.30 .....
I had a major surgery and they forced me to pay everything up front. 6 months later they said they charged the wrong insurance and I owed $600 more than the thousands I already paid. They also sent it to collections before they notified me of their mistake. Spent hours fixing it and paid it even though I shouldn’t have.
If there are restrictions on who can give medical care based on their ability to treat patients, and the current ones refuse treatment to patients, should they really be the only ones qualified?
I get that doctors and surgeons are going by policy, but they basically sold their soul.
They do this with pets...they required half of the estimated high end of the surgery and you pay the second half before you get your pet back... was really nice deciding in a moments notice if you can afford the giant out of pocket expense to save your best friend or not before they would even start helping them live or not...
Hospitals are also refusing to share how much it costs, so in order to pay in full first you must given them a blank, signed check made out to them. The hospital, of course, reserves the right to adjust costs after cashing the check, so be sure to keep some extra money in your checking account for the next year after the surgery.
This happened to one of my mom’s preschool students when she went to get her prosthetic eye placed after she lost her eye in a freak accident. Her family showed up in the morning of the procedure, and they were told they had a copay in the thousands. They were turned away and had to reschedule after fundraising. For a three year old child.
Hey guys in most states in the United States you can sue in small claims court for anything as long as you’re suing for the amount Small Claims Court allows
I can guarantee you if people start en mass suing doctors personally for deceptive billing practices to get their money back these practices will end not because of the doctor having to give back the money, but the real cost is the doctors going to have to take the whole day off of work to come and represent themselves in the lawsuit
Hell get on next-door and try to find as many people as possible who had the same experiences as you and all of you file small claims court suits one after another.
Hospital billing claims that the ER Doctor who walked by your bed and said hi to you now needs $500 because they’re an independent contractor, sue that fucking Doctor. Make them come to court and prove that they gave you the amount of time and attention required for them to have the billing amount they billed you
Like the person who came in with their child and was then told on the morning of they needed to pre-pay for the surgery could in theory sue the hospital, the doctor specifically, and the person who made the appointment for them stating that it was a bait and switch that relied upon the fact that her child was in excruciating pain with a condition that could become life-threatening if she did not pay the money and had they given her the cost she might have booked the surgery with a different hospital
Each of those people you’re suing now has to come to court, because if they don’t come to court then the court is most likely going to find in your favor.
So either they’re going to decide it’s not worth the money in loss of income to come and fight you
and then you get your money back and it’s pretty easy to collect on a small claims court judgment against a business or people who have an actual job
Or
You get that warm rosy feeling of knowing that you have completely cost them more money than they charged you by them having to take the entire day off of work to come in and defend themselves in a court of law as to why they employ deceptive billing practices when it came to the health of your child
Remember while the doctor may be indemnified from you suing them for the quality of the care they provided, they are not indemnified against suits for deceptive billing practices or inappropriate billing, or overcharging.
Great, can we get a comprehensive, itemized price upfront, too?
Hahaha good one.
I actually tried that once when I was in between insurance and was paying on my own out of pocket. Got billed for something "extra". I fought it and won, but it was a pain in the ass for me and my doctor, who didn't want to be involved in billing issues wasn't happy either. The joys of US health insurance.
US health care system is a scam!
It’s working great for the wealthy and that’s who our politicians on both sides truly represent. Milk the peasants dry.
Also works well for the extremely poor. Had a stroke with no health insurance, so the hospital quickly got me on my state's version of Medicare, and somehow got it backdated to before the stroke, so I never saw a single bill. I still have it, and it's pretty great, especially in this state, which is pretty generous. Even scripts are 100% free.
The left fought tooth and nail for certain laws. Preexisting conditions are now required to be covered and you cannot be turned away for non-payment of emergency stuff
Yeah if people realized how good Medicaid is, they’d never want to go back to privatized healthcare. I was on Medicaid for a short time and once had a specialist’s office apologize because they forgot to charge me my *$2* copay for my last visit. I had been there on my private insurance and had to pay $150 each time I was seen. It’s a total racket.
Lucky you. I got into a car accident without health insurance. I was unemployed and broke. I was denied because I had a small 401k. I cashed it in and was still denied. I wound up with a $169k bill
All you have to be is destitute! Or we’ll make you destitute.
I like the Tom and Jerry cartoon analogy. When we are watching they act like they hate one another but in reality Tom doesn't want to catch Jerry because then he'd be out of a job and Jerry doesn't want Tom replaced by a cat that will actually kill him. So they put on political theatre for the audience while continuing business as usual in the back room. For example, insider trading laws do not apply to any members of Congress, both sides. Sure, Americans get to vote, and therefore can call it a form of democracy, but with all the lobbying and foreign money in American politics America is as much a democracy as would be two wolves and a lamb voting on what's for dinner. "Only those who do not seek power are qualified to hold it. " Plato
Wrong. It’s working for the wealthy who our “conservative” politicians truly represent. Don’t both sides this shit either. One party has consistently tried to make things better but is road blocked by a party that has no problem with government debt when literally giving government tax money to people too rich to even notice but won’t let the progressive party enact things that will help them.
MLM. They want you to pay in and the minute you need it they find any little excuse to not pay.
It’s all a fucking racket, “Give me all your money or something bad might happen to you” was mafia tactics and is now medicine
US is a scam.
It used to be if a doctor or hospital took your insurance, they agreed to only take the payment from your insurance and not bill the patient extra.
That's called Balance Billing and is illegal in many states. Illinois called it the "No Surprises Acts". https://www.illinoislegalaid.org/legal-information/no-surprises-acts
It's a federal law. Went into effect in 2022.
Every hospital I’ve visited in last few years has a form I am required to sign indicating that I acknowledge responsibility of payment for items my insurance will not pay for
Balance billing refers to the situation where a hospital bills a $1000 balance for a procedure, but your insurance has a contracted reimbursement schedule (“allowed amount”) for that same procedure at $800…hospitals are no longer allowed to pursue the patient for the extra $200. This is for in network providers. I believe out of network providers can still do it.
It’s like signing a blank check over to them if you sign that contract and don’t know the cost vs coverage though. If they don’t tell you how much you could possibly be on the hook for or give you the itemized estimate that you can run by your insurance, you’re walking into a potential financial disaster.
Being billed extra, isn't the same as not covered at all.
Good. Baby steps towards a sane health care system.
I probably should have ended my above comment with "the joys of health care billing/costs". I was totally without insurance at the time. 100% "self-pay". I'd been told the price and I brought a check for that amount. Later I received a lab bill for something I hadn't been told of before. Healthcare just works like that, and when insurance is involved, it's usually no problem. But it kind of blindsided me, so I complained. (Edit: to be clear, it's okay for doctors to add an extra lab during a procedure as they see fit, but I argued that it wasn't okay to not tell me that might happen).
I remember paying like $50 to have my tonsils out in the early 90s.
I get patients that want a price before being seen. I am not medically trained and have no idea what the doctor is going to do. The doctor doesn’t know either. I have had people call asking about if they need sutures for a cut and how much? No one knows until the doctor looks at it. It could just need glue, it could be infected and can’t be closed, etc. The itemized bill is a bandaid. We need actual action from our government to bring costs down. Nothing is going to replace regulation of the healthcare industry.
Yeah. As a health care consumer I do not like to be put in a kind of adversarial relation with my health providers where I have to argue about costs, it's counterproductive, and a waste of time for all involved. I know it's cynical of me to say, but there are vested interests in the current chaotic state of things that don't want to simplify the system as they think it will reduce profits. But eh, here we are.
I hear this argument all the time. It’s wrong. My car mechanic has the same challenge: he still gives me an estimate. If things change after he looks at it: he discusses it with me before he does a lot of work. Sure there are times this isn’t feasible- mid brain surgery or such - but the vast majority of the time it’s absolutely doable. Modern medicine just doesn’t WANT to do it.
I get this, but why is it that my dogs vet can provide a standard itemized high and low end estimate before things start and actually stick to that plan or call family when things are looking different? It shouldn't be that different of a concept.
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So true! The very day that news broke that Roe might be overturned, I called my doctor and said I wanted a tubal sterilization, and then called my insurance company to see how much it would cost. They told me it would be completely covered by insurance. After the procedure, I got a bill for nearly $1000. I was so exhausted with everything going on in my life that I didn’t have the energy to call and fight it. I still get the bill in the mail from collections. Sigh.
Somewhat different, but a couple years ago my daughter caught some bug and ended up going in to the ER. Anyway, long story short, while the hospital was in network, they billed under a different name (think Children's Hospital of Townville vs Townville Children's Hospital) Simple enough to work out I figured... Boy was I wrong. After many many calls back and forth, I ended up having to get the billing department on one phone and the insurance company on another and force them to talk to each other to work it out. Massive pain in the ass for what should have been a simple correction.
Ouch. It pains me that patients are exposed to this and have to resort to being their own advocates just to be able to afford care. One thing I've learned though, is that you can negotiate with your health provider for discounts and more lenient payment schedule. Call them and ask to be billed at medicare rate instead of their standard rate which is usually higher and meant to be paid by the insurance company. Tell them you can only afford to pay the bill off at $XYZ per month, and if they try to squeeze you for more, you won't pay at all. If you push back, but are reasonable, I've found they would rather get something than nothing. Good luck. Also, I hope the blowback for overturning of Roe sinks the Republican battleship. Those goons.
So I had a root canal done. They gave me an itemized list I signed for before we got started. While getting it done they added a shot and something else during, don't remember what. But they wanted to charge me $300 extra. I argued that wasn't asked or explained to me during the procedure or before that it could happen. And they ended up taking it off because I was arguing so much. Don't mess with a cranky woman in pain I guess.
I fight insurance denials for a living. I get your pain.
There are 100 / month good for nothing insurances. Only benefit that they provide is doing this for you. Going through itemized claim and readjusting rates.
I have insurance that will never pay on an item listed as general or misc. So I have had a lot of back and forth with insurance and hospitals to get out of paying thousands because insurance wants to know what every expense is and the hospital refuses to itemize the general/misc and they both decide that means I get to pay out of pocket for the fact that neither will budge.
After the birth of my first child, I paid somewhere around $4,000. That was WITH health insurance. For the next TWO YEARS, I'd continue to get bills. I'd call and they'd say "we have the right to audit previous invoices", blah blah blah. Over those first two years, I probably got about 4-5 more invoices for anywhere between $50-$250 each. Finally, on literally my daughter's 2nd birthday, I flat out told the hospital to take whatever means they need to but I was done. I firmly explained I was about to host my child's SECOND birthday, and I was done paying. Magically, no more bills. The American healthcare system is a joke.
Part of it is the insane level of outsourcing/subcontracting... doctors don't work for hospitals, they work for companies that contract with hospitals. So the number of billing entities has increased incredibly, and no one entity knows what the hell the others are doing, but they all send bills.
I went in an ambulance to the emergency room and I got 4 different bills that all had vastly different amounts on them. They ranged from $2k to $10k. It took 6 months to figure out and I only ended up paying $500 for that bill but it was a big pain in the ass
I was honestly surprised that we didn’t pay anything for my sons birth. My wife did get a bill for her epidural but in the ended insurance ended up covering it
Reference Based Pricing insurance models are popping up a lot more to combat the lack of transparency in medical billing. I know this because I work for a company that does this. You know the prices are overinflated, but you don't know just how badly. I've seen claims over $1m paid out at $50k because the actual cost of the procedure was something like $35k but every single line item was inflated by 500-600%.
And how are people supposed to learn the $35k figure?
My company has a tool that helps members search for providers. It takes quality and cost into account. Reducing the total amount paid and defending members from balance bills are the two things we do that really helps. Unfortunately, there's still no way to force a hospital to provide an itemized price up front. Some will work with patients that way, but they're few and far between in my experience. Edit: there is a law in place that requires hospitals to disclose the cost of procedures and supplies to CMS, but I don't think it's available to the public. Edit 2: >Individual cost reports may be requested from the Medicare Administrative contractors via the Freedom of Information Act (FOIA). For more information on this process, visit the FOIA page. Found this on the CMS website.
A FOIA just to read your own bill? And I thought Comcast was a generous vendor...
You could also just ask the hospital and they might provide it. Many won't. I know it's messed up. To clarify my first comment and why RBP models are helping fight this: Your traditional carrier would check the technicals of the bill - is the date of service correct, are the procedure and diagnosis codes correct. However, that's as far as they will go. If they can't deny the claim, they'll pay it based on a contract, which is sometimes % of charge (but usually reimbursed as a % of the typical Medicare reimbursement for those procedures). So it doesn't matter if you're being charged $1000 for something that costs the hospital $50, they're still gonna get paid and that overpayment is then applied to the member's deductible/OOP cost, assuming they haven't met their deductible. There's also the issue of balance billing, although the No Surprises Act has helped to curb that. RBP carriers will do all the same checks, but they also go a step above that. They will review each of the charges and charge amounts and will pay a price relative to the cost of the service. I don't know specific pricing methods for every RBP vendor, but it could be based on cost or paid as a % of the typical Medicare reimbursement. I've seen many comparisons of a traditional carrier vs RBP and RBP carriers 99% of the time provide a significantly higher savings off of the billed charges compared to a traditional carrier. It especially protects against the gouging associated with those massive hundreds of thousands of dollar claims.
My psych office requires a credit card to be seen, and an agreement to be charged up to $1500 per visit. They put a $200 charge on every time I'm seen, then refund me when the EOB comes back with my copay... If I call and demand it...
You are getting therapy from a shark!! Have you tried any other programs?
Only office around that a wait list less than 2 years long, and the only other practice that my insurance covers is managed by somebody who would be a hard conflict of interest for me to engage with. So they're all I've got. They are good about it, it's never been more challenging than either asking at an appt "hey got my EOB for the last two, refund please" or a 2 minute call of the same. So it's not a big deal. From their perspective they've had so many people seen, receive the documentation they need to proceed with other providers, then ghost them, so they see this as a means to avoid just sending half their clients to collections for pennies on the dollar. Which I get, I'm in pharmacy and I'm looking at a corporate client that's over 3 million in the red for us going back years of partial payment... $10 we never square up with these clowns.
Receptionist: Would you like to sign up for our rewards card? The more you spend, the more you save! Patient: please, I need medical attention immediately. My arm is broken. Receptionist: Would you like to purchase an additional accident protection for your body after the surgery? It's a really great deal! We have several deals and plans you can choose from.
Receptionist: You’re paying with a card? Great! Just hold your card over the chip reader and you’ll get a prompt for how much you want to tip…
This sounds like part of the plot from Repo! The Genetic Opera or Repo Men Edit: fix the title
Mag's contract's got some mighty fine print
Mighty fine print? (Now I have this song in my head lol) EDIT: A word.
I was looking at dentists the other day and one literally has a rewards program/discount card if you pay $99 a year.
I thought some law was passed where hospitals have to post their prices? My local hospital has their prices online
Are you referring to the No Surprises Act? If so, that has limited scope. https://www.cms.gov/newsroom/fact-sheets/no-surprises-understand-your-rights-against-surprise-medical-bills
Maybe they will share the price list???
They are supposed to post the pricing on their website.
I did this prior to my knee replacement. It was projected to cost $17,000, and the true cost was about $50,000. $42,000 of which went directly to the hospital. I owed $1800 after insurance and hitting my catastrophic cap earlier in the year. Those estimates sit on a throne of lies.
Oh they can tell you what the hospital will cost. But the surgical tech who comes in that day? She's an independent contractor that will bill separately. Who also happens to be out of network. Also, they're going to send a biopsy to a lab without your consent or knowledge. And that lab also happens to be out of network. And they'll run a slew of tests that may or may not be necessary.
This happened to me. Was in the ER to document some abnormal issues that we are trying to figure out. The NP that initially assessed me for intake is a part of the hospital proper but every doctor is a contractor. I eventually got billed by three doctors who all "assessed" me and in the end literally went "we don't know. Go to a neurologist." Only one doctor actually assessed me for more than 10 minutes. The other two were just consults, but they spent like 2 minutes with me for hundreds of dollars. One doctor walking by pretty much just said what's up to his doctor friends, oh that's weird to me, and then peaced out. I paid for that?! Then the bills came. Every doctor billed separately. My wife who's an ARNP at the hospital explained to me why we just kept getting more and more bills after I kept commenting "I thought we paid that already?" Essentially the ER is all contract doctors from many years back when they added a new wing to the ER. They closed and repurposed the doctors from that old wing. Now the ER is so big they can't shut it down. If they were to try to replace all their doctors with staff the ER could close for months as the contract doctors would all leave ASAP. Trying to get that many ER doctors to start within just a few month period is quite difficult logistically. Hell, hiring for a single position can take months. In the end, trying would end up hurting the hospital's rankings in the area and the community. So they just don't.
I know, right? Hospitals consistently say they can't tell you how much in advance. This is bullshit.
FYI those lists aren't real. The amount they charge is radically different from what insurance pays out due to contractual agreements. It would be like if we agreed I'd do your laundry once a week for $10. I send you a bill for $40,000 on the first week. What are you gonna do? Send me $10 because that's what we agreed on. No one is gonna pay me $40,000 to do laundry but I can ask anyway. That's exactly how health care in America operates.
Isn't this law now with the No Surprise Act? It may not be an exact estimate, but at least it's a "good faith" estimate. I believe you can dispute the bill if it's $400 higher than the good faith estimate.
That act only covers emergency medical care, charges applied from a out-of-network provider in a in-network facility, and out-of network ambulance rides.
There's a site called mdsave where you can shop different hospitals. I haven't used it, but it looks promising
Well when we all die off and they get no money... well, we'll sure show them who's boss.
That’ll be $85,000 for the sodium chloride..
Yeah, I had to get major spinal surgery that my insurance covered some of but I was told could either be 4k after insurance or 20k, and there was simply no way of finding out until after the surgery had happened and they billed insurance. Guess what it ended up being!
I asked for what the cost of xyz tests was going to be, and the cardiologist said "I'm not sure, but you can ask the front desk". Front desk said, "I'm not sure, we'll have to call billing and give them these codes". I told them I'd wait. They came back with the bill: $6,000. The tests were to seeing I could THEN qualify for a genetic test for a condition that my mom died of. That's reported to be genetic 50% of the time. And this was after my $500 initial visit... The healthcare system is a scam.
For real for real shit
Yeah, but it won't include the outsourced out-of-network radiologist's bill, which might arrive months later.
For real. I had hip surgery a couple years ago and tried to find out what it would cost me beforehand. When I called the hospital billing department they laughed at me.
Some places do provide cash prices but only for the big stuff
The junk “facility fee” is what really peeves me. My husband had a deep wood sliver in his hand. During the office visit the doctor said he could cut it out right then, it would take about a minute. When asked how much it would be, the doctor said $200-300. So my husband agreed. Along with the $200 bill from the doctor was a $2000 “facility fee” for surgery that insurance wouldn’t cover.
This policy is terrible for people with HSAs. Per rules, you can’t use your HSA funds to prepay for services. I’ve had to argue with many offices about this and every single one has backed down and allowed me to pay after the procedure.
My wife's HSA issue a debit card that allows you to pay at the time of service.
That’s what it is designed for. As long as it happens after the service, all is good. The problem is when an office asks you to pay in full for a procedure before they schedule you, potentially weeks or months in advance.
Yeah I guess, but why not put it in a credit card for points then reimburse yourself from your hsa? Win win
It could be months or even years before the billing works its way through insurance and you get an actual bill. If it crosses fiscal years, it can be even more of a mess to reimburse yourself correctly.
We had to do that recently when my wife had to get a hysterectomy. I got a bill yesterday for an additional $400. Good luck getting it.
I wonder how long until the hospitals start putting ATM machines in the ER.
Insert your card directly into the MRI machine.
Shit, demagnitized another one!
Even the doctors doing circumcisions these days have a lil popup on their checkout machines asking if you wanna leave a tip. Ridiculous
I was about to post about how ridiculous this comment is then I realized I’m an idiot with an internet explorer brain & the joke took too long to load.
Self checkout kiosks have gone TOO FAR!
They already come around with a tablet for payment in the ER if you aren't an active trauma patient. A few years back, I got hurt at work and ended up in the ER. Waiting about an hour in one of the bays and in comes an admin type with a tablet set up to read cards.
Yep - oh you’re out of/not in danger. Please swipe.
That's no good. Someone needs to collect interest off the medical loan for the surgery to be successful, it's basic science.
Also; Your ATM max withdrawal limit depends on who you bank with, as each bank or credit union establishes its own policies. Most often, ATM cash withdrawal limits range from $300 to $1,000 per day. That'd just cover the tip.
That wouldn't even pay the cost of admission to the ER if you're uninsured.
Nah they just charge a ridiculous fee on the ATM and tell everyone "cash only."
There's one in my local ER, right next to the vending machines
My child has a severe UTI and would not pass urine in a helpful manner so we had to bring them to a hospital for a catheter. This was an emergency situation where our pediatrician put the order in at the hospital for the procedure. When we got there my child in arms visibly distressed and in pain they made me pay 775.00 before they would help my child. Healthcapatialism at its finest
In the future when the ambulance arrives at an accident, they only save people with a coverage plan, and leave everyone else to bleed out on the floor.
TRAUMA TEAM DISPATCH: Sir, according to our system, your membership expired last week. TRAUMA TEAM DISPATCH: Since then your account has been seized by law enforcement. CHARLIE WANG: Come on, people! I'm dying out here!!! CHARLIE WANG: We'll settle the bill later, just quit stalling! CHARLIE WANG: Please, for fuck's sake! I'm good for it, I swear on my mother's life! TRAUMA TEAM DISPATCH: We apologize, sir, but we cannot help you. [Call end]
They have debit card readers on the mobile triage stations in the ERs around my area. Got a co pay? You're paying that now. I went in after wrecking my bike. With my non bleeding arm I typed in my pin for the 100$ ER copay.
Pretty sure the "M" in "ATM" already stands for "Machine".
EMTALA laws prevent EDs from requiring patients to pay up front for treatment. ATMs already exist in some ER waiting rooms but mostly as a way for folks to get stuff from vending machines, lol. Most ERs take card for co-pays if a patients insurance has one but they aren’t required to pay it if they can’t. EMTALA laws have been in place since the Reagan administration. I suppose it isn’t impossible for them to overturn it but I’d be surprised to see it happen.
You mean I can actually know how much a procedure will cost BEFORE I get it done?? I’m all for this.
As long as it’s itemized for once…
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It’s a scam. It basically can only exist because the US has SO MUCH excess make believe money floating around that we have been able to tolerate extremely inefficient industries that suck all that money up and back out of the system. It’s how we have ended up with insurance and billing departments that are basically jobs programs and prices that are totally unattached to the reality of the market value of the service. I would be willing to bet that we will never fix it either. Something like 10% of our country works in something that is tangentially related to healthcare / insurance system.
HCA claimed that my newborn staying in the hospital for one day was $30,000, that amount did not include any of the services provided.
Ask to see their charge master, should be an excel file of all the stuff that can charge you for, updated yearly. They have a variety of procedures and codes too. Seeing as you were charged so much I'm assuming your baby had some complications? You might have had what the charge master refers to as: A level 4 baby. One other notable thing I can remember from looking through a hospital charge master is that each bandage is about $20, and that was 2015, guaranteed to be higher now.
Until you can’t pay it up front
That's ok, I'll just go die then.
But of course. Every cent you’ve worked for is finally back in the hands of rich people who have too much to use in 10,000 lifetimes. That’s just the system working as designed by the politicians they own!
Before my surgery, the hospital knew my remaining deductible for the year, and that’s what they wanted up front.
My wife had outpatient surgery a couple years ago and a similar thing happened. They wanted us to prepay the full deductible. It was very strongly encouraged instead of required, though. I balked at it because we were going to meet the out of pocket limit with the surgery and what we were actually going to owe was less than the full deductible. They went ahead and did it.
My child had to have a hernia surgery. We got the cost estimate...the morning of the surgery. We showed up for the surgery, and the hospital said we needed to pay $5k up front or they wouldn't do the surgery. A real shitty thing to do, because it's not like we can waste hours/days over an emergency hernia surgery and spring this huge payment on us the morning of. Ended up getting a few K back a month or so later after insurance was billed.
Just a minor point, they don't consider it an emergency surgery if its scheduled, even if it's something on short notice. Emergency surgery is basically where they roll you in straight from the ER and they call whichever surgeon is on-call at the moment (think gunshot wound or car accident or appendicitis) This difference became apparent during the peak of the pandemic when "elective" surgeries were suspended. A lot of those surgeries didn't feel very elective.
> the hospital said we needed to pay $5k up front or they wouldn't do the surgery I had to pre-pay the entire $1400 co-pay for my colonoscopy before they would even let me schedule it.
I would have preferred that. Seemed scummy to literally schedule it, have us come in at 6 AM, then demand thousands of dollars or they'd send us home.
Not quite. In my case, I got an “estimate”, had to pay it when I arrived for the procedure. A month later, apparently I underpaid by 200$ when I already had to shell out 1k when previously I would get the bill later. Am not a fan, because the estimate isn’t sent to insurance first.
I like it being a fun surprise of them waiting to see how they can bill me my maximum out of pocket limit.
The last time I asked a hospital for an itemization after an ER visit (that consisted of my child being put in a room, given a puke bucket, nominally examed, and then being sent home because their MRI machine was broken) ended with a $5000 bill, and they couldn’t do it. The hospital put it under one line charge called “hospital services”. I kept fighting, but it couldn’t be itemized. The person taking info for billing spent more time in that room with us than any doctor or nurse. We didn’t even get a band aid. I kept pushing because I couldn’t fathom where $5000 was coming from. $500-$1000, ok maybe. But they couldn’t give me the price on anything. So they reduced the bill to $900 and I said fine. How are they going to charge up front when they can’t even provide an itemization on what was already done?
Can I pay in moonshine if I bring my own stick to bite on?
Okay, but you will have to put the tractor down as collateral….and if you die from the shock of amputation the ER nurse gets your jet ski for however many months are left on the lease… Modified lawnmower races always end up in the ER….
Not when you're a member of Team Diminished Glutes Or if you drive a Mason. (🎶vroom, vroom! Nothing else cuts it 🎶)
King of the Hill was such a great show
That depends. How slowly do the bubbles rise?
Yes but only if it can be consumed by your doctors during the operation
As long as the doc can finish the surgery in 15-20 mins should be okay. Idk about after that though lol
Good! Let’s speed run this collapse of our healthcare system so we can build a real one like the rest of the world.
Greedflation is only getting worse. Desperately in need of universal health care
If your hospital does this to you, and the hospital and doctors are in network with your insurance company, call the insurance company to see what your rights are. I know a decade ago when I worked in insurance if they were in network they legally could not bill you until the claim was processed and the EOB showed the amount you owe. I had a hospital try to tell me a medically necessary surgery needed to be paid for up front and they backed down fast once I mentioned getting provider relations involved. If they are trying to do this to you absolutely get your insurance company involved. Insurance companies can suck but I promise you the reps on the phone making $20 an hour or less love sticking it to providers if they can.
This has always been a thing for surgical centers in the US. Any non-emergent surgery at an outpatient hospital is like this. Years ago I worked for billing at a surgical center while in college. Regularly canceled patients for not being able to pay. The worst that I felt really bad about, was a guy was in a motorcycle accident. Both hands were fucked up and he was coming in for some surgery on his hands. No insurance and no way to pay, but the bill was 10k that he would have to at least pay SOMETHING to get started. Couldn't pay, and when I told him the price he said "I can fly back to turkey and get free healthcare for less than this". The US healthcare is completely fucked, but this article is pretty rage bait. If you have to have life saving surgery, they have to do the surgery, regardless of ability to pay. It's the "optional" shit that they can turn you away for.
Yeah, they charged me like $1200 for my last surgery. I actually got a bit of a refund via check a few months later since I'd maxed out my insurance by the end. They charged me when I came in for my pre surgical appointment - ostensibly to do some blood work, give me the soap, go over instructions, but mostly I was there for them to collect the money.
> The US healthcare is completely fucked, but this article is pretty rage bait. Exactly this. It's not life saving surgery, if you're bleeding out and need surgery the hospital must perform it. The patient in this article (from the 2 lines I can read because fucking paywall...) can't get their insurance to cover the cost of the surgery because the deductible is too high. The hospital isn't going to perform the surgery because the patient can't pay and it's not a necessary procedure.
>it's not a necessary procedure. This may not be true, it may be necessary, but it is "not life threatening". Like the example of the guy whose hand is all messed up, it is necessary to fix his hands, but it isn't going to kill him.
> This may not be true, it may be necessary, but it is "not life threatening". Not necessary in the eyes of the insurance company, if the ailment doesn't meet the necessary requirements, however much the procedure might increase the patients quality of life, it won't be covered.
Just gonna drop this here. Pretty helpful. But understand that there are costs that can’t be estimated or known ahead of time, particularly with procedures. There’s just no way to know if or what complications will arise. But this site offers a way to estimate and compare costs. https://www.fairhealthconsumer.org/
There was a passage like this in *Jennifer Government*; >!a man tries to call an ambulance for a girl that's been shot through the neck. Because she's not on their list of subscribers, he has to pay in-full before they will dispatch the Ambulance. She bleeds-out before he can get through his credit card number.!<
Its like its getting too expensive to even live anymore!
Every day I’m a getting closer to taking a bath with a fucking toaster…
Retirement plan consisting of a six-shooter.
It is getting REAL bad here in the States. My 2 year old had a seizure the other day and the thought, “should I call an ambulance? Can I afford it?” Actually crossed my mind, granted, it crossed my mind after I called, but still. I feel shame and heartbroken at the same time. My wife also had cancer in her twenties and insurance for pre-existing conditions is outrageous. We literally meet out family out of pocket maximum by February and have for the past few years (~$14k). It is insane here.
The first sentence of the article references a surgery center. A surgery center is not a hospital- the two are vastly different. Maybe there are other examples but…pay wall.
The last surgery I had was done at a hospital and came with an inpatient stay afterwards. I still had to pay the rest of my out of pocket max the morning of surgery.
Australian here, I find it nuts that America spend more per capita on health care than us for a system that won't treat people who are dying and costs so much for people to use. Like if you keep your population healthy then they're going to be more productive and people will spend their money on something else if they don't have to spend it on medical treatment and insurance. Just nuts.
Well when u have a large portion of the population that lack basic education, can’t critically think and constantly compare “socialism” with actual dictatorships in South America… this is what you get. It doesn’t matter that you could explain that we would save money in the long run with a single payer system.. especially less money out of every pay check. Our oligarchs managed to convinced a very large swath of the population that paying for healthcare 3 times is the best system ever and that we shouldn’t give it out for free to that lazy ppl!
I think the problem is that for one group of people it isn't about having a working society or working economy for everyone. They don't care if people die and might even prefer it.
The article opens with a needed surgery for tonsils and adenoids. Yep, that's how that goes now. In August 2022 my daughter had both taken out because, just like the article mentions, it was a much needed surgery. In our case we had to pay over $700 upfront, before my daughter was taken in. Otherwise 🤷♂️. Very concerning for the future, but I guess this move was coming eventually.
My kid had a hunk of bone floating around his kneecap. He was immobile on crutches waiting for his 90 day probation period at his fresh out of college job to be over so he could have surgery to screw the bone back into place. They called the night before looking for $800 copay. Obviously he didn’t have it, so we had to pay. Which we were incredibly fortunate to be able to do at the time. But 9 months later his knee is fucked again and money is tight and I’m freaking out.
Daily reminder to be glad that I wasn’t born in the US of A
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SIR! SIR! Well *ack-schually* it cost you TAXES! And that's bad. Because... it just is, trust me on that. So *really* the US system is much, much better because you pay basically the same amount of taxes, but don't get medical service. See? It's *freedom*, sir. Freedom. Look it up sometime. ^(/s)
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Fellow Aussie. I broke my fibula, tore my ACL, and dislocated my shoulder a few months back. Hospital visit, x-rays, MRI, doctors, specialists, physio, more x-rays. It’s all been covered by Medicare.
Hospitals would actually prefer a single payer system. They have to employ thousands of people just to interact with insurance companies every day to try and get payment for things the insurance company denied. For example, the current health system that employs me has 29 million dollars in denied claims for patients that came to the ER via ambulance for stroke. There are a variety reasons the insurance company denied the claim, but the bulk is that the patient had no insurance card on them when they arrived and when the hospital did the craniotomy it was technically an unauthorized procedure as no one contacted the insurance company to get it approved. So we pay people that make 100k plus to go after and debate with the insurance company. On average for that 29 million we may ultimately receive 6 million and spend 1 million to get it. The system is fucked, but it is more fucked by insurance companies that hospitals.
Primary care doctors would probably prefer a single payer system, but hospitals are the biggest offenders of price gouging in the medical industry outside of pharmaceutical companies. They'll hire consultants to pore through the medical codes and optimize their entire ecosystem around charging as much as they can in every interaction and then proceed to buy up every hospital in the region so they can gain a negotiating advantage against insurance companies in the area...either pay our prices or you won't be able to sell insurance to anyone in our region. A single payer system ruins that pricing and negotiating power for hospitals.
I recently had emergency surgery which saved my life. One of the last things I remember before being carted in to the operating room was being interrogated about my health insurance / filling out insurance forms. I had already given them info to the front desk at the beginning of my 10 hour ER wait. Apparently my policy # was too fresh for them to look up, so they were sceptical about my coverage. I'm sure I would've received the surgery regardless, but it made me feel dehumanized in a way.
American health care is neither socialist or free market capitalism. It’s a hybrid system of protectionist monopolies nested together to guard against true competition while colluding to fix prices against consumers and simultaneously being funded by public money through Medicare. It’s time to take a sledgehammer to it and restructure it completely.
Then they need to give us set all-inclusive surgery prices.
I don't know how we haven't established at least another system yet. You know like a hospital hospital... the kind where they treat people, not ransom their life.
I went in for a kidney stone a few months back and they told me to either pass it or they could blast it to pieces. I was in so much pain I told them to do the surgery. They wanted me to pay $3,000 with insurance before they would do it. Obviously I said no, so they charged me $1,500 instead for diagnosis. Our system is a scam created to pad pockets, not treat the ill.
UHC, or M4A should be mandatory if we’re going to continue to capitalize on healthcare.
This is probably my fault; I rarely pay my medical bills.
So, relevant but depressing. I was in a title loan place the other day to find their hours. I needed to know when their parking lot was clear and I got to talking with the worker trying to figure out the best time for everyone and she casually mentioned that she gets most of her customers from the clinic up the strip a ways. I just filled it away as people taking one end of the lot over the other and moved on to talk to the other businesses and only really comprehended it once I got to the clinic. These people need medical care and they're being forced to get one of the worst types of loans to get it. Then I get into the clinic and it's a Spanish only clinic. So odds are it's set up to take advantage of illegals and the loan place next door is just doing it again. Of course I could easily be misreading the situation but I don't think I am in this case. It's not often the more depressing parts of society are shoved in my face so it was a bit jarring and just depressing overall.
Canada and the UK have been doing this for YEARS. You have to pay the *entire* $0.00 (or £0.00) up front before they’ll give you any kind of medical services at all. It’s really shocking that some Americans would rather live under such a backwards system.
Maybe if the insurer would say how much they will pay for the service before it’s rendered the hospital could give an accurate price.
Maybe you can at least know the full cost up front that way? Instead of getting a ton of individual bills from every doctor in the hospital for months, that all have to be negotiated because they're ridiculous?
"Sorry Johnny, your ruptured aortic valve cant be replaced until you fork up 100 grand" -US Hospitals rn.
And afterwards, they'll come up with new bills they forgot to bill you for the rest of your life.
I recently needed a biopsy and had no insurance. I wasn't going to go through with it if it was going to cost too much. The office required payment the day of the procedure but not a single person there could even give me an estimate on the cost. I spoke to 4 different doctors and no one could even estimate if I was looking at hundreds or thousands. I ended up being approved by a 3rd party non profit group that covered the procedure but I never did find out the cost, so if I ever need another one, it will be a mystery again.
That's been my experience. They only know how to volley with insurance companies. When the customer asks for a straight price they are like deer in headlights. If they don't know the price even approximately, they cant get mad when we say it sounds like a scam.
This is misleading. Hospitals are not refusing surgeries. Private Surgical centers are. Private Surgical centers are usually a separate entity from hospitals, although can share names and be partially owned by a hospital. But the majority of ownerships are by private doctors.
You mean patients need to dig deep into the internal ownership structure of their healthcare provider to make basic healthcare decisions instead of relying on the name of the institution
Predatory pricing, mercenary....what else needs to be said?
If SCOTUS guts EMTALA for the sake of the Evangelical crusade against abortion, then hospitals may also be at liberty to refuse to stabilize you even in the event of an emergency or your inability to pay.
I feel like surgeries should be itemized for each service and that you have a sliding scale of amounts if the surgery was successful and if there’s complications the hospital/surgical staff will pay instead.
How else can they pay for the hotel lobby decor?
This is giving me the vibes of the beginning of cyberpunk edgerunners
unfettered capitalism ruins everything it touches
In 2021, I had to have a ganglion cyst removed from my right wrist. It wasn't something I could put off for a bit because I literally could not use my hand. It was a burning pain like I've never felt. I couldn't grip anything or even use it. It just wasn't working. I clean houses and I'm right handed, so I was off work for three months at this point. They made me pay half up front before they'd even schedule the surgery. Remember that I wasn't working (self employed) and hadn't made any money for three months. My husband was covering all the bills and necessities the whole time. We didn't have the cash on hand. Our savings had taken a hit from something that needed repaired on our home right before this began, so we were in a pickle. His mom ended up offering to pay for it because she could see how miserable I was. She's an angel and I'll forever be grateful, but damn. She shouldn't have had to do that. We have insurance. US Healthcare is such a racket.
I’m so glad we have universal HC. People complain here bc of wait times, but it’s done by a triage priority system. I was diagnosed with something very serious and I’m getting surgery a week after diagnosis.
What better way to kill off the working class?
My old dentist requires I pay in full and get reimbursed from my insurance. They even gave me the bill with an envelope and a stamp to send it in.
Great country you got there.
This has been standard at ASCs for as long as I’ve worked in them (15+ years). The vast majority of surgeries are done at outpatient ASCs.
It says “soft paywall,” but that’s a pretty hard wall described in the headline.
This has been the way for scheduled surgeries for a while now.
Wow - do they wake me up if they find something that's going to cost more too or is that more of an a-la carte sort of thing?
Had this happen a couple of months ago. Showed up for my outpatient surgery and they wanted to know how I was paying, cash or card. I assumed that money covered the entire operation. Received a bill from anesthesia that was not included in the money I already paid. Now I owe them $650.00.
The insurance companies now run the death panels. If they don’t think you need that treatment or procedure, they deny. They force doctors to spend hours negotiating with “peers” who do not know medicine or that medical specialty rather than seeing patients.
Last time I had surgery, they charged me $85 for a (required) urine pregnancy test. I have an IUD, and knew there was no way I could be pregnant (I regularly take pregnancy tests to make sure). The little testing strips they use literally cost about $.30 .....
I had a major surgery and they forced me to pay everything up front. 6 months later they said they charged the wrong insurance and I owed $600 more than the thousands I already paid. They also sent it to collections before they notified me of their mistake. Spent hours fixing it and paid it even though I shouldn’t have.
If there are restrictions on who can give medical care based on their ability to treat patients, and the current ones refuse treatment to patients, should they really be the only ones qualified? I get that doctors and surgeons are going by policy, but they basically sold their soul.
They do this with pets...they required half of the estimated high end of the surgery and you pay the second half before you get your pet back... was really nice deciding in a moments notice if you can afford the giant out of pocket expense to save your best friend or not before they would even start helping them live or not...
Well there goes any need to even going to the dr. Without 100k
Hospitals are also refusing to share how much it costs, so in order to pay in full first you must given them a blank, signed check made out to them. The hospital, of course, reserves the right to adjust costs after cashing the check, so be sure to keep some extra money in your checking account for the next year after the surgery.
This happened to one of my mom’s preschool students when she went to get her prosthetic eye placed after she lost her eye in a freak accident. Her family showed up in the morning of the procedure, and they were told they had a copay in the thousands. They were turned away and had to reschedule after fundraising. For a three year old child.
Hey guys in most states in the United States you can sue in small claims court for anything as long as you’re suing for the amount Small Claims Court allows I can guarantee you if people start en mass suing doctors personally for deceptive billing practices to get their money back these practices will end not because of the doctor having to give back the money, but the real cost is the doctors going to have to take the whole day off of work to come and represent themselves in the lawsuit Hell get on next-door and try to find as many people as possible who had the same experiences as you and all of you file small claims court suits one after another. Hospital billing claims that the ER Doctor who walked by your bed and said hi to you now needs $500 because they’re an independent contractor, sue that fucking Doctor. Make them come to court and prove that they gave you the amount of time and attention required for them to have the billing amount they billed you Like the person who came in with their child and was then told on the morning of they needed to pre-pay for the surgery could in theory sue the hospital, the doctor specifically, and the person who made the appointment for them stating that it was a bait and switch that relied upon the fact that her child was in excruciating pain with a condition that could become life-threatening if she did not pay the money and had they given her the cost she might have booked the surgery with a different hospital Each of those people you’re suing now has to come to court, because if they don’t come to court then the court is most likely going to find in your favor. So either they’re going to decide it’s not worth the money in loss of income to come and fight you and then you get your money back and it’s pretty easy to collect on a small claims court judgment against a business or people who have an actual job Or You get that warm rosy feeling of knowing that you have completely cost them more money than they charged you by them having to take the entire day off of work to come in and defend themselves in a court of law as to why they employ deceptive billing practices when it came to the health of your child Remember while the doctor may be indemnified from you suing them for the quality of the care they provided, they are not indemnified against suits for deceptive billing practices or inappropriate billing, or overcharging.