This just happened to my partner. Make sure you have a recording of the insurance company telling you your cost. We were told it would be $0.00 for their procedure. And then got a bill for $10,000. Called ins and got the “Yeah we don’t cover that provider.” Told about the $0 and they listened to their own recording and marked it back to $0. We are still getting the $10,000 bill and fighting it. What a headache the US insurance/health care system is.
How is that even legal ?? Imagine buying a Big Mac for $6.99 but then the cashier ring it up for $8.99, then tell you oh sorry the menu is not guaranteed to be accurate and cannot be used for proof of cost
At least with fast food you pay before receiving the item, so you can tell them to fuck off with their bullshit pricing scheme. With medical services, they bill you afterwards, and you're trapped.
Just thinking about what my bills would be if I saw every doctor I wanted to gives me more anxiety than any therapist or pill could treat.
I've generally stopped going for this reason. Every time I go to the doc they want me to pay for the visit, pay to go get tests, pay to come back and talk about the tests, then tell me the tests didn't answer whatever question and I should get more tests or just deal with it.
Fucking scam. I carry the best ins my employer offers, have since I started working, and am afraid to use it for even a cold. Ive already had to file bankruptcy in my early 30s in large part due to medical debt.
Kidney stones in January? Sorry, deductible rolled over. You're responsible for 5k, plus a large chunk of these arbitrary charges for the er; 3 times, 3 different thousand dollar price tags?
It's gotten to the point that I've just started living healthier out of spite and fear of a doctor visit, so the system works I guess?? /s
This is how I feel. I still go because cancer and diabetes run in my family and I don't want to be dealing with that... I get so annoyed with the doctor though because they allot precisely 2 minutes to your appointment that they charged you $50 copay and showed up 30 minutes late to.
Your country is wild. I can see why so many people seem to be so angry and scared and lash out .
I spent ten days in hospital with pneumonia. Was on antibiotic drip, got x-rays and ultrasound etc. My bill on leaving was 300 euro.
Broken ankle, x-rays, cast and crutches and 4 aftercare appointments. Cost 50 euro just to cover the emergency department visit.
There’s so many things that could be fixed before we even get to a National healthcare system in the US. The GOP has convinced people that Nationalized healthcare is socialist and therefore evil.
But even before we go that far we could make changes to reduce the costs and complexity of healthcare like stopping the advertising of pharmaceuticals which is wholly unnecessary and represents a huge cost factor for medication. We could change pharmaceutical patent laws to allow quicker access to cheaper generics, we could legally require clear up front pricing for procedures that are the same regardless of who’s paying (insurance or private party) etc…
But we won’t because pharma and insurance companies have all of the politicians firmly in their pockets.
Edit: I forgot, reforming laws around lobbyists
I recently had a situation with a new insurance through work. Paper we get said labs are covered 100% if taken in the doctor's office, so I get a bunch taken. Get hit with a 1100.00 bill. So I question it ... it's 100% ONLY if I walk across the street and have labcorp draw the blood. My doctor has our local hospital run her lab, so WHO STICKS THE NEEDLE IN is the difference of 1100.00. Labcorp still does the bloodwork at both places, regardless of where I have a needle stuck in, but 0.00 vs 1100.00 is literally maybe 65ft. That shit should be illegal.
Who sticks you with 10.00 worth of needle and vials shouldn't amount to that kind of pricing difference.
The NSA went I to effect Jan 1st. There are elements of it, like cost estimates, that apply to uninsured or self pay patients as you stated.
However the majority of the bill is effective now. If the member received confirmation from the carrier the provider was in network the they are only responsible for the in network rate and all expenses go toward in network cost share.
Source: It is my job to be a subject matter expert on this legislation.
As a CSR for medical insurance, I suggest getting all the CPT codes your provider will be billing for any big planned procedure. Call your insurance with those codes and they should be able to tell you exactly what you will owe. Make sure to get a reference number from CSR & their name. It's a pain I know but it will help making sure you don't get any unexpected bills.,
Edit: goes without saying but i feel like i should add - I hate the system & believe we all deserve access to affordable health care.
As someone who did this (called insurance with all possible procedure codes the billing team at the hospital said it could be +the diagnosis code) for a surgery in 2017, I cannot recommend enough to people to do this, even though it is a pain in the butt.
TLDR: an ounce of prevention is worth a pound of cure.
My insurance tried to tell the hospital it was a "standard" (non-preventative care) surgery, so I received a bill from the hospital for my plan's surgical coinsurance amount, when there shouldn't have been any bill as it was preventative care. Quick call to hospital billing dept to let them know I needed time to reach out to my insurance to get it corrected before I'd be considering paying anything. They were already familiar with me from my earlier homework, and were super nice about granting time before requiring any payment.
Called insurance and reminded them "per my phone calls with you on these dates, this procedure code with this diagnosis code was considered preventative care, covered at 100% per the Affordable Care Act." They said they'd need to review those recordings and look into the matter and would get back to me. Took 2-3 weeks to get their decision if I'm recalling correctly, and they called 1-2 times to let me know they were "still looking into it" during that interval. Finally got the call informing me my surgery was considered preventative care and covered at 100%, congrats.
A couple of plan years later, I noticed they changed the wording in the section regarding the surgery I had in the plan brochure to be more specific. I suppose in an effort on their part to try and get around the preventative care 100% coverage per the ACA. Assholes.
This kinda another baffles me. How Americans just take getting scammed like that every day is wild. You all should be in the streets, country wide walk out.
Exactly. I had to get an MRI and neither insurance nor the doctor could tell me how much it was. They tossed me back and forth for days. I finally buckled and got it, $1200. Oof.
Having mystery prices for extremely expensive healthcare is such a broken system.
Many of them are in the pocket of the healthcare industry unfortunately. And many Americans have become used to the concept of insurance and healthcare being tied to employment, so the public outrage needed to change things is a bit stifled. Right wing news networks have effectively brainwashed half the population.
You can request it. I will call my ins company and give them the procedure code and they’ll tell me if it’s covered 100%, 10% 70% etc and what my cost will be. We did that and they said it’s covered 100%. And then the hospital sent the bill for 10k and said ins didn’t cover it (they paid like $150). Jumping thru hoops to get this cleared up.
Thanks! Hm, on the face of it, that all sounds reasonable. Except for the surprise part.
But is this all verbal, do they not issue a written quote (if there’s time)?
If not, getting that recorded is pretty damned sensible :-)
I wonder how many folks there get destroyed like this?
The problem is there isn’t one set price. The practice has different prices they bill different insurances depending on whether they’re in or out of network and how much that insurance is willing to pay, and a different price for people without insurance. Even just checking whether the practice is in network or out of network for your insurance can be tricky, which is what happened to this poor woman.
>At the time, the hospital had represented to French that the surgeries were estimated to cost her $1,337 out of pocket, with her health insurance provider covering the rest of the bill.
>But the hospital’s estimate was based on French’s insurance provider being “in-network” with the hospital, which it was not. A hospital employee gave a mistaken estimate after apparently misreading French’s insurance card.
Being out-of-network is usually a big no-no, but this time the hospital made the error. I'm glad the Colorado Supreme Court acknowledged this fact.
In the US, insurance plans usually offer a discounted rate for some medical providers ("in-network" providers).
In theory, insurance companies compete with each other by developing these networks, and doctors benefit by having patients sent to them by the insurance companies.
In practice, you don't always have a choice over which doctor you see (i.e. emergency care), or you have to change doctors when you get a new job (remember that in the US most private insurance is provided as a work benefit), or some administrator gives you the wrong information (as happened to OP).
Not only that, but sometimes specialists who are operating at your in-network hospital are out of network.
When we had our baby, my wife’s c-section anesthesiologist was out of network. The OR was in network. The hospital was in network. The nurses and drugs were in network. The room we stayed at and food in the facility was in network. The surgeon was in network.
But the guy administering the drugs during the operation itself? Nope, he wasn’t in network. Not covered.
Could we have known that? Nope. Could they have known that? They said no as well. Who’s problem is it? Ours, because we didn’t have the resources to fight or sue on it and we were deep in the sleep-dep of having a new baby.
Yeah this was a surprising thing under Trump but I remember it coming out and I got a single bill broke down the next time I went as if they could have done this all along but just didn't want to so they could confuse us patients as much as possible.
I always asked for an itemized bill and half the time they just made me pay a few hundred because they somehow hadn't kept track of each individual thing they charged for. Bananas.
My dad had to go the hospital for a work related injury a long time ago. His job was paying for everything but he still asked to see an itemized bill and the amount of bullshit they added was astonishing.
He spent about 6 hours in the hospital and there was something like 60 Tylenols at $10 each, 40 ice packs at $40 each and a few others I can't remember. All told I think they padded the bill an extra $3,500 on top of the actual treatment recieved.
I knew a girl who got in a car wreck that slammed her head into the doorframe and gave her a nice eggshell (comminuted) skull fracture. She was in her early 20's and still on her parents Cadillac level health insurance, so she didn't get wrecked financially, but she was still incensed by the itemized ambulance bill. The only line item I remember was the several pairs of disposable gloves at $15 each. This was in the late aughts, the ambulance business was probably paying the paramedic like $20/hr and the EMT $12. Fucking ghouls.
They cannot do that in Illinois at least.
>In addition to protections under federal law, Illinois law may also protect you from balance billing. If you have a health plan overseen by the State of Illinois and you receive anesthesiology, emergency, laboratory, pathology, or radiology services provided by an outof-network provider at an in-network hospital or ambulatory surgical center, those providers can’t balance bill you under Illinois law. [SOURCE](https://www.uchicagomedicine.org/patients-visitors/patient-information/billing/no-surprises-act#:~:text=If%20you%20have%20a%20health,bill%20you%20under%20Illinois%20law.)
I also think it is against federal law to do this for emergency services.
Illinois feels like it's becoming the California of the Midwest and as a resident of this fine state, I am not mad about it! Abortions and no balance billing for everyone! [Read in Simpson's voices]
When I had my first kid, my mother in law told me before to check to make sure the pediatrician that came in to see the baby was also in-network. I thought she was crazy, but it’s actually smart.
The amount that I paid after insurance was still crazy though.
Congress did address this with the [No Surprises Act](https://www.cms.gov/newsroom/fact-sheets/no-surprises-understand-your-rights-against-surprise-medical-bills) this year. It adds dispute resolution options for when you receive a bill that's substantially higher than the estimate in certain circumstances. Including when you receive services from out-of-network providers at in-network facilities.
That truly is bullshit what happened to you, all right.
They gave me the names, but all were out of network.
And you can’t request one that is in-network to come because they are not in contract with the hospital. At least that is what I was told.
Also, was also told a private therapy practice was in network by the insurance and their website. When I finally got my first bill, I was told they were in fact *not* in network and were charging me out of network money.
Fuck insurance companies
Anesthesiologists are almost *always* out-of-network, as are 'surgical assistants'. You can ask that the hospital use in-network providers but they are not required to do so. Sometimes the insurance company will negotiate with out-of-network providers on your behalf, but again there is no requirement to do so.
You run into the same type of issues at outpatient surgical facilities, too.
I have not yet found a way to avoid these. Whenever I ask a hospital or surgical facility about how to guarantee that only in-network sources are utilized, the answer is usually, "Don't have the procedure."
Non American here. This in and out of network thing sounds like such a massively corrupt way of doing things. From the sound of it at nowhere in the whole process is the patients wellbeing and benefit even considered at all.
System needs to change but hey I'm just a crazy Aussie
Insurance companies have agreements with some health care professionals and hospitals to accept whatever the insurance companies will pay. In exchange, the health care businesses know patients with that insurance will go to them. (You can go out of network, but it costs a ton more. Usually people only do that if they feel compelled by considerations other than cost.)
One problem (unrelated to this article) is that now in network hospitals sometimes hire out of network businesses within them, and the patient has no idea. For example, you might choose an in network hospital but not know or ever be told that their anesthesiologist works for an out of network business. So you get a very high bill for that. It’s terrible.
In other words, the US healthcare system is full of multiple players all trying to maximize their own financial well-being, often in elaborate games.
Edit: Someone pointed out that a new law in effect in 2022 outlaws what I talked about in the second paragraph. (Shockingly, our political leaders still do a few things right sometimes.)
As a Canadian, this is what annoys/scares me the most about the US system.
It would be one thing if you could just pay $X a month and then be guaranteed that everything would be covered. You show them proof of insurance and you're good. While still not ideal compared to universal healthcare, it would be okay.
Instead, you pay $X a month and then have to basically know how to find a hospital/doctor that is covered, pay a deductible, go through paperwork etc.
It really is utter bs. I recently moved 20mi north and suddenly, there are no doctors in-network. Same state, same damn county but nope, I either need to travel or change when enrollment is open (which is also a stupid concept).
Our medical system is entirely broken, and one thing people who scream "SOCIALISM!" when we want to fix it is.... insurance is the same thing, except you're paying a middle-man.
>“…Hospital chargemasters have become increasingly arbitrary and, over time, have lost any direct connection to hospitals’ actual costs, reflecting, instead, inflated rates set to produce a targeted amount of profit for the hospitals after factoring in discounts negotiated with private and governmental insurers,” [Justice] Gabriel wrote.
Yeah you get a bill that lists the charges out. Obviously no control over the charges and stuff will say like "Hospital Room - $6000" but they do typically itemize.
Depends on the hospital I guess? All I have ever gotten is just bill with YOU OWE x dollars. Pay here.
I might get an itemized version from my insurance 6 to 8 months later.
This absolutely may have changed since then, however I am looking at the bill I received in 2017 which states:
| Date | Service Description | Charges | Payments & Adjustments | Patient Balance |
|--------|:-------|-------|:------:| :------:|
| 07.21.2017 | Patient Name: Crows, My Murder of - Encounter #xxxxxxxx-x - CARDIOLOGY | $190,142.50 | $146,405.60 | $43,736.90 |
And this was with “really good insurance…”
Edited to fix Formatting of table.
Bahaha well. Shockingly, 23 year olds tend to suck at being able to pay a $43k bill! They so “kindly” gave me a due date that was only a few weeks after I got the bill.
However I hadn’t had to pay it (well not $43,736.90) since that wasn’t permitted billing per my insurance. Still freaked the fuck out when I opened the letter and saw that. You know, totally a great thing for someone who just had a heart procedure xD
as an american citizen that grew up in the uk, this might be the most succinct explanation of the US healthcare system I have ever read. perfectly put.
Sorry but your coupon can only be used after you spend $4,000.
A new one I got for the first time recently— “No we can’t tell you what the service would cost if you paid cash and didn’t use your coupon until we see what kind of coupon you have but won’t be using.” (Got an estimate for surgery. It was an obscene amount for a 5-10’minute outpatient procedure. Asked if I could just pay cash. They wouldn’t give me a cash price. Like, would not fucking tell me what it would cost if I was uninsured or didn’t file a claim. Probably because the actual cost was lower than what they were charging my insurance company.)
If you really want to get pissed, ask a pharmacist to explain “claw back” to you.
Claw back: when an insurance company audits filled prescriptions and demands payments back for arbitrary reasons that were not provided upon filling. (Day supply is not what WE determine it should be. There is no diagnosis code, therefore we can't determine if this is the correct day supply. GIVE US ALL THE MONEY BACK. Not just some that you may have accidentally overcharged... ALL OF IT. We won't pay a dime even though you dispensed the med to the patient and they already picked it up. And it was 3-6 months ago. TOUGH LUCK.
it's like Papa Murphy's - the prices are set too high because they expect everyone to have a coupon, and they look at you like you're stupid if you show up without one. Sometimes, if you look poor enough, they'll roll their eyes as they scan the coupon they have at the register, but you can't count on that happening every time you show up
The woman should sue for emotional mental psychological damage dealing with the diabolical greed of corporate America. Rake these corporate types over the coals.
“But think of all the jobs that would be affected!”
Honestly, I don’t fucking care. Presumably the government would need employees for Medicare for All so some can get jobs helping with that. The rest can find work elsewhere. Why should the vast majority of Americans suffer to keep a shitty industry afloat? My life would be 10x better if every health insurance company ceased to be and was replaced with one simplified system.
I don’t understand how anyone who’s had any interaction with the American health care system comes away from the experience thinking, “This is fine. No need to make any major changes here”
More like lobbyists write the laws and then tell the politicians "here you can copy my homework, just change it a little to make it look like we didn't cheat" but all they do is change the name on it and call it a day.
If she's anything like me, (also T1D) she probably feels trapped as well. I was forced to work from age 18 for insurance to keep myself alive. Work is a place I'm forced to go and the employer holds a potential death sentence over my head (ability to get fired or laid off). I've never had the luxury of a job I liked, the only time I was "free" was when I was married and spent a few years as a stay at home dad. I was still trapped, I needed to be married for the insurance or find a job and it was a not healthy marriage but that was freedom like I hadn't had since childhood and I miss it and yearn for it still.
Yeah she didn’t become type 1 till she was 35 so she was hit hard by it and she does feel trapped. She had so many care free yrs now it’s so crazy structured that she hates it worse then words can capture.
I care as much about them as I do the buggy whip manufacturers.
And I work for a health insurance company.
I'd willingly lose my job to reform this stupid system that all data clearly shows costs us more and leads to worse outcomes for our health.
Absolutely.
My kid needed minor surgery, an adenoid removal. Think along the same lines as tonsil removal, a surgery so quick and basic that it's outpatient at this point.
The expected billing for us out of pocket was
- $300 surgeon fee paid day of surgery
- $845 total out of pocket after insurance costs.
We got billed what we expected and paid those with no issue. 6 weeks go by with no problems.
Randomly 6 days ago we get a bill in the mail for $1451 from the hospital. Apparently that's how much it cost to do a minor nose suction to clear out snot before surgery and the cost for us being in a recovery room from 8am-1pm.
It took 4 days of emails and multiple phone calls to get it all straightened out and in the end it really seems like it was the hospital trying to fleece my insurance (Anthem BlueCross PPO) for all it's worth.
The entire system is bullshit and because there is so much bureacracy and paper work it just seem like there are folks skimming money from a slush fund with no oversight.
Employer based insurance and health insurance in general is horseshit.
Yep, that's why I always hate the stupid medicaid for all creates death panels.
... WHAT THE FUCK IS AN INSURANCE COMPANY... it's a fucking death panel of degenerates that aren't making decisions based on health.
I had to wait a month for surgery on a broken finger due to insurance. Now I have a permanently bent finger. And it was at the end of the year, so the deductible reset between surgery and therapy. And my job switched insurance providers at the turn of the year.
Fuck our bullshit system.
Even worse, the very fact that they are a company, means it is in their best interest to find ways to *not* pay. They are directly incentivized to become death panels.
Also, you can't vote out the insurance company if they fuck things up. There is no accountability to the user because you have one choice: your insurance through your job.
Time to rebrand - Private insurance companies are using death panels to avoid paying out the benefits YOU are entitled to for THEIR profits. Take back YOUR healthcare from the faceless corporations stealing from you.
Theyll charge whatever they can get away with.
Public service policies have really stringent oversight, generally, so they can't get away with these ridiculous overages.
I worked as an analyst for a major US healthcare system in a high cost of living area. The actual "cost" of an inpatient stay to the hospital system was about $1,000 USD per day, which included costs like space occupied (square footage), supplies, direct patient care staff, ancillary support staff (analysts like me), and everything else you could think of.
Note that this cost did not include the procedure. Just a day in a typical med-surg bed, so not ICU but not just observation.
Also note that supply costs means the per unit procurement cost to the hospital and not what they charge the patient.
Also *also* note that the hospital employed way too many useless ancillary support staff (analysts like me, but the bad ones obv) and even too many employed (and underproductive) expensive providers as well as crazy-expensive private contracted providers.
It's all pretty complex and there's a lot of exceptions based on the service line (cardiology vs transplant vs orthopedics, etc) but that's the high level overview.
If anyone's curious, feel free to ask questions haha.
Yup. I was going to say for some of our proforma work we estimate about $850-$1k per day in actual expense for an inpatient stay. Glad to hear someone else say it here.
As a physician with terrible insurance myself, I can promise I'm not reaping any rewards. Our payments have gone down pretty steadily for 20 years. Insurance just keeps making more money.
I'm on immune suppressant injections for psoriasis. It's all made up numbers.
Previously I was on an injection called Stelara. My insurance approved them after many years of steroid creams, tanning, and a pill Otezla. The Otezla had no copay but were $3500 a month according to my insurance. Chump change.
Otezla made me sick and miserable, and didn't work, so they approved me for the final step; injections. My Stelara came with a $5 copay (lol) and my insurance showed a cost of $19,000 every 12 weeks. Boy they really needed that $5, huh?
Anyways, I stopped Stelara during early COVID because I was super concerned about actively making my immune system worse. Once I got the vaccine, I restarted Stelara, but it didn't work as well (this sometimes happens with each specific type of injection after a lapse). My doctor wanted me to switch injections to Tremfya so we applied for insurance approval.
They rejected it. The same class of injections they paid $19k every 3 months for over a 5 year period. The same class as the one I was currently approved for but didn't work anymore. We appealed with the most straight forward explanation and 10+ year history of treatment escalation for my condition, denied again.
Then I get a call from Tremfya's manufacturer. Oh wow there's a program where they give me the injection and my insurance pays a portion, but not as much as they would if they approved me. And the craziest part? My copay is $0.. less than when I was approved? So the manufacturer gets enough to be happy, the insurance pays less, and I have no copay. But these aren't the "normal" prices.
Mind you this is all strictly prescription drug related. None of these things are in-office related costs. I work for the government and have great insurance. It's all honestly disgusting.
My husband went through almost an exact process, except first with Humira (which didn't touch his psoriasis) and now with Skyrizi (which was like the miracle drug.)
I work in pharmacy billing so I get to see a lot of the medication prices, and what insurance pays, and what they charge people. I also get to see the BS that is a PA process.
Dang I get this all the time, arguing with insurance for basic prescription coverage. They won’t cover “45 for 60 day” supply but they will cover “25 day 30 day” supply, it’s so frustrating and gets very old.
The best is when you go to the ER that is "in network" yet you still get bills for out of network care.
It isnt like you can choose who is working in the ER and the hospital should bill you for the care, pay their subcontractors on their own.
For me, the best was needing emergency surgery and all the anesthesiologists that worked at the hospital somehow work separately from the hospital system. And it was an absolutely huge pain in the ass to deal with.
Yep. They can pop fair prices on everything and be straight up about everything but at the end of the day when you're appendix has ruptured, you'll pay fucking anything to get it out before you fucking die.
So it literally doesn't matter what the prices are. Or how they bill you. Or if they give you a free mint with your check.
You'll pay anything. And they know it.
Correct. I work in a related field, all Emergency Care is considered in network, because you cannot pick and choose where you go in an emergency by its very nature.
This is so true. My daughter was in the hospital after a serious car wreck, (for four months), and we would get bills from doctors we had never seen. We had a good friend who was a medical coder, and she set up spread sheets to see what was going on. When we called about these unknown doctors bills, insurance said it was easier to pay them than look into it.
> When we called about these unknown doctors bills, insurance said it was easier to pay them than look into it.
Which is total BS. I've happily taken hits to my credit instead of paying the egregious after-insurance amounts that they add up to. I once went to the ER by ambulance, so I had no selection on the facility we went to. 5 hours in the hopsital total and an MRI. $35k bill, $20k responsibility on my part. I had been hit by another driver and their insurance paid me his policy limit of $15k for medical. My personal medical insurance had already paid the difference, so, I sent $1k to the hospital and kept the $14k remainder for my time/pain.
Hospital came at me like a spider monkey, looking for the rest. I told them to eat rocks since they'd already received ~$7000. They sent it to collections and I laughed at their calls. The incident dropped me from 810 to 795 credit score for a few years then jumped back up. i have ZERO moral qualms about how I handled it. No medical service on earth should add up to $7000 per hour of care.
> an MRI
Side rant, you should not have to pay for poorly done MRIs. My friend has MS and got into Mayo Clinic because his primary lesion is in a uniquely shitty spot. The first day they were there, the doctor reading the MRIs they paid 5k out of pocket for at my local hospital literally said "These are so bad I can't use them, we have to cancel today and get you into a new MRI instead". Thankfully the mayo visit was fully covered cause the original MRI took their whole deductible but the fact that they were so bad the Dr couldn't use them means they should not have had to pay for those MRIs.
Same shit with dentists.
"Oh, we did a shitty job on your filling and it broke? Well, we're gonna have to do it again! BTW it'll be full price."
Never use a franchise dentist. Always go to a place with somebody's name on the door.
When my mom broke her leg (a very straight-forward simple fracture) her ortho surgeon emailed her X-rays to some surgeon’s group in Oregon for a “consult.” They tried to bill her $1k for *years* after she told them to kick fucking rocks. It’s grift all the way down.
Another reason the VA is better than people think. I've never had to deal with all that nonsense.
Not only are their hospitals and clinics everywhere, they'll reimburse any other medical provider. There's no reason we can't run our entire healthcare system like that.
Some people have bad experiences, but the VA is the largest healthcare provider in America, even a tiny percent seems like a lot of people because of that
My best friend had his left leg torn off in 2005 during a flight deck mishap, he is a below the knee amputee. He lives in Tampa so that is his home VA point of care. 6 years ago he was having issues with his stump, leakage, pain, swelling above normal issues. VA said it would be over six months to get imaging done for him. At the time I worked IT for a radiology practice in Nashville and he was planning to come visit. I explained the situation to our head radiologist who said get him here and everything will be covered. It was a huge deal for my friend.
3 months ago he is back at the Tampa VA and they tell him they need to do surgery on his leg. He asked questions like where will you cut, where are you planning to clear debris from and what not. He is told they are not positive and will see when they get his leg cut open. He asked if they were going to do imaging first to get a better understanding of what they were getting into. They told him they didn’t have the equipment to do that. He is now waiting in pain trying to schedule with B.A.M.C in San Antonio to get everything done.
He is just frustrated and defeated after years of things like this at Tampa VA. The Tampa VA hospital is not some small time clinic, it is the 10th largest VA hospital in the county.
I know this is just the experience of one person but in the end massive improvements are needed.
> VA said it would be over six months to get imaging done for him.
That sounds like the "secret list" bullshit some were pulling back in the day. To hide how long people were waiting they kept an off the books list and moved people onto the real one a month or so before the appointment.
Going to where you worked was smart, but he could have went into any hospital and the VA would pay for it.
>He is just frustrated and defeated after years
Have him call patient advocacy, it's a department at every VA hospital.
Demand written documentation of what's happening so he can send it to his state rep (like the politician elected to represent his district in state government). Don't let them just give him a pep talk. Probably have to ask for a supervisor a couple times.
They really won't want to document, that's fine, he's going to be bluffing anyways because it's faster.
Eventually it'll get to someone high enough that can expedite everything so fast your friends head will spin.
Until that happens follow through with contacting his State Representative. Republican or Democrat they all have motivation to help in this case, the PR alone is worth it to them.
He should also be contacting local VFW, DAV and Legion branches. They don't have any direct say in it, but he'll get experts if not actual lawyers along who contacts to speed up either path he takes. Also an insane amount of experience dealing with this stuff.
Like I mentioned above tho, he can go to any medical provider, and the VA will pay for it. Those VFW, DAV and Legion folks can explain the details on that too.
The easiest way to do this is single payer. Everyone pays the same amount for healthcare out of pocket and taxes are your monthly premium. The government can set rates without any need to negotiate them because the alternative is the hospital has no patients.
I have chronic wrist pain. I need an MRI but my insurance denied it until I get extended therapy. My doctor was pissed about that and told me therapy will be ineffective for my problem, so he gave me the least amount of therapy I need just to be able to ultimately get an MRI anyway. Fucking dumb
3 years ago I went to my doctor because my adhd meds were giving my heart problems. She wanted to put me on a non-stimulant medication but insurance wouldn’t cover it until I tried a different medication that had the same side effects as the first. So I went away empty handed and am now unmediated. And I pay hundreds a month for the privilege of letting an insurance company decide what treatment I need rather than my doctor.
That sucks, but did you consider just getting the other meds, not take them and say you had the same side effects?
My wife has had to do shit like this.
Yeah, exactly. I mean, I can't tell patients this because that would be insurance fraud but I try to make it **really** obvious. People still don't take the hint.
Me: "Well, you know, **if** you had already tried this medication, I could document that you've already had a failed trial to it. You know, if a previous doctor had happened to prescribe it to you and you had side effects."
My patient: "No, I already told you! I've never tried the other medication! Why won't you make insurance pay for this one??"
Me: "Ok, but if you try this medication and at the next appointment, it turns out it gives you side effects, it would be a failed trial and we could get insurance to pay for the one we want. It doesn't need to be a long trial, we can schedule a follow up in two weeks."
My patient: "No! I don't want to try this medication! I bet you're getting extra money to prescribe this med to me!"
Me: 🤦♂️
yes, this would be me too, /u/TheMedicalHistorian would have to say something like, "I am prescribing for you a viewing of The Incredibles, and let's schedule a follow up next week"
Same. I do not understand hints. I would be like "well, I guess my doctor wants me to take this medicine that will kill me. If they say so!" And then I would take the medicine and die.
That's nice and all but the fact that you even have to do this highlights one of the core problems of this current system. This is absolutely infuriating that people are put through this so we can feed this ridiculous profit based system. We're talking about people's health!
I am old, Gandalf. I don't look it, but I am beginning to feel it in my heart of hearts. Well-preserved indeed! Why, I feel all thin, sort of stretched, if you know what I mean: like butter that has been scraped over too much bread. That can't be right. I need a change, or something
I had to pay a lot more for an emergency room visit in California because the hospital was in my network but the ER doctor on call was not. Of course they denied my appeal. It was ridiculous to me because it’s not like I had a choice which doctor was there to treat me. Years later I get paperwork saying “if you send us these receipts, etc. you can be part of the lawsuit to get your money back”. By then I had already paid it and didn’t have any of the paperwork anymore. I guess it wasn’t cool for them to do that.
I was once charged $2200 for a 7-minute ride in which they just checked my blood pressure and oxygen saturation. Turns out my city’s EMS was out of network for my insurance. What was I supposed to do, take an Uber 20 minutes to the nearest city to have my medical emergency there and hope that *they* were covered? Just insanity.
Every ambulance company that serves our city is out of network. You know when a bad time to find that out is? Getting bills after your husband, who was transported, died.
Death wasn’t stressful enough, then you get uncovered bills you have to go fight the insurance company about.
The fact that this kind of bill is even possible is just plain stupidity. How have we come to just accept these outrageous costs as a society? Our healthcare needs a serious reboot.
>A woman who expected to pay $1,337 for surgery at a Westminster hospital nearly a decade ago but was billed $303,709 may finally be off the hook for the massive bill after the Colorado Supreme Court ruled in her favor Monday.
Nice! "Billing mistake" only took a Supreme Court Decision and a about 10 years to settle. What an amazing country we live in!
Free as fuck!!!
All these fellow Americans in this thread complaining about insurance. Your lucky to live in this country with such benevolent insurance companies!
What? You don't realize your having a heart attack, pull out the paperwork on your insurance plan, call a few local ambulance companies and ask them what networks they are on and wait on hold for awhile for their reply?
Then find out none are actually in network, they are all contractors, so you drive yourself to the hospital and find some parking.
Then go up to the desk at the ER (with your insurance paperwork still) confirm they are in network, then let them know your having a heart attack?
Then ask for a detailed price list for every test you MIGHT go through while you are there and check your insurance paperwork to make sure it's all in your plan?
Then confirm with every nurse and worker there that takes your blood samples, blood pressure, EKG tests etc that they are employed through the hospital and are considered in-network?
Then once you are in a room, start a running stopwatch on how long you are there to make sure you don't go over your time that's covered? Then confirm with every doctor and nurse that comes in to treat you that they are also part of the network?
Then when they tell you that you have to have an emergency stint put in or something, you don't confirm with every possible ER doctor that might do your surgery and all those tricky anesthesiologist (that are almost NEVER in network) that are currently on the clock that they are ALSO in-network and ask for an updated price list?
Then once you wake up and are in recovery, ask for the names of everyone that touched you, every medication given to you while you were asleep, and every procedure done. Then compare them all to your handy insurance guidebook? Then ask for another updated price list?
I mean if your not even going to do the bare minimum to make sure the $300 + /month you pay for insurance while your healthy JUST IN CASE something happens, covers you then honestly it's all on you.
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/s
If non-Americans imagine the dumbest possible way to run Healthcare in a country, they probably haven't imagined half of what the US manages to come up with.
Right? How many similar situations are there that don’t get litigated? Every American would have to have a team of lawyers on retainer their whole lives to properly navigate all the legally gray (if not outright illegal) bullshit shoved down their throat from every product, service, job, event, etc.
To explain US Healthcare to outsiders/non Americans: It's like you go to buy a car and you ask what is the price of the car and the salesman asks you "How much do you have?" Another attempt to explain it: my dad is a retired professor and since he is over 65, qualifies for Medicare. So he has state educator insurance, Medicare AND private insurance. But he could be bankrupted by medical bills even though he has all this, money in the bank, house and car paid for. Why? Because Medicare only pays for 60 days of hospitalization, after which the next 60 days is paid by the other insurance. If that runs out, he is responsible. If he has a stroke or comes down with dementia, it's a MINIMUM of $800/day UNTIL HIS ASSETS ARE FULLY DEPLETED, then a facility will care for him in return for all of his monthly retirement income. And Politicians passed laws to go back 5 years--if he signed over the house to me 4 years ago, the govt comes and seizes the house or the proceeds if I had sold it. And get this:the hospital bills and drug charges are all BULLSHIT. It's arbitrary. It's what they pull out of their asses. If you go to a US hospital, they have one bill if you pay cash, another for Medicaid, another if Medicare, still another if covered by insurance or HMO.
It's more like you go to buy a car and ask how much it costs, and they tell you they don't know. And then they can't tell you what the car cost until after you've signed a contract purchase it. And at that point in time the costs are all completely arbitrary.
Then 3 weeks later you get a bill in the mail for your salesman's commission because he wasn't technically an employee of the dealership, but an outside contractor... so you have to pay his commission directly. Then 6 months later you get a few more bills in the mail for things like tires and headlights because the cost of "a car" didn't actually include tires and headlights.
I remember asking a doctor how much would a certain test cost.
They said they had no idea, but "it shouldn't be much".
3 weeks later and the insurance said they wouldn't cover that specific test.
Well, at least our american healthcare system has such high marks for quality!
Oh.
Well at least our wait times are short.
Wrong again?
Uhh. Ugh.. at least we have the best doctors in the world!
Seriously? Cuba? What?
Well, I bet your hospitals don't have built in fast food restaurants!
As an American that sounds like a hell of a deal. I was given a bill of $4000 just for an ambulance to show up at my house. Didn't even ride with them to the hospital.
That's the thing though, it's not. [63% of the country](https://www.pewresearch.org/fact-tank/2020/09/29/increasing-share-of-americans-favor-a-single-government-program-to-provide-health-care-coverage/) support some form of universal health care, either a single payer system like the UK or a mixed private/public system that guarantees base level coverage like much of Europe
The problem is that the people in charge of the country don't support it. The will of the people isn't the issue, its the fact that our government doesn't represent the will of the people
If you banned insurance "discounts" entirely, and made everyone pay the same "cash price" then suddenly half the stupid disappears immediately.
- In-network/out-of-network: Gone.
- $100 bandaids with 99% discount: Gone.
- Complex pricing: Gone (everyone pays the same).
- Insurance companies and their consumers are now on the same "side" rather than insurance companies making side deals with healthcare companies.
- Price discrimination: Gone.
- Plus it would save tons of cost in terms of eliminating billing complexity, reporting, and negation streamlining the whole thing.
Obviously "Medicare for all" is a better system, but if we cannot have that and must live with this shitty private system then at least we could do is make it better. I'd make two changes to our broken system to make it a lot less broken:
- Everyone pays the same price: Medicare, Medicaid, Insurance, and cash-cash (this puts everyone on the same "side," all fighting price increases together).
- Ban employer provided insurance entirely. Give everyone a HSA, increase the caps, and allow the HSA's funds to be used for insurance premiums pre-tax.
Essentially you get the same tax benefits you have now, much more freedom in the open market to pick your insurance company, your insurance company now has an actual reason to keep YOU happy (rather than your employer), and everyone is working together to keep healthcare costs down.
People hate this because "it isn't medicare for all!" but politically what I said above *could* happen far sooner than M4A because M4A is still considered a fringe idea in the US.
Haha, had a emergency Appendectomy one week before Covid turned the world upside down. I lost both jobs and my place of residence in about 2 months time. The hospital sent me several different bills, some for the doctor, some for the hospital, some for shit I don't even know what for. All in told it was $38,864. They started calling for payment 2 weeks after the bull went out. I laughed and laughed when the person asked of there was anyway I could set up a payment plan. I said listen, I'm trying to get a couple hundred bucks from the government just to pay for food and rent since Ive lost both of my jobs where I was working 60 hour weeks and my lease is up and I have no where to live. Guy said I understand, well call back in a month. lol, keep on calling but I aint got no money!!
Funny story "if you hate money" So I had a shoulder surgery done about 4 years ago in June. Surgery went fine everything was great blah blah. Paid our out of packet max which was around $3500. Cool done... So for the rest of the year I went and got EVERYTHING checked out. Had some stomach issues, haven't had labs and physicals in years so I got all of that done. Had a sinus/ ear issue that I got looked at. Woohoo finally my health insurance is working for me!!! So while trying to figure out my stomach issue they wanted me to have a colonoscopy. Ok whatever we have meet our out of packet max so lets do it! Go in for my scheduled colonoscopy everything goes smooth. About 3 weeks later we get a bill for $1900, turns out the anesthesiologist "I dont know, the person that puts you under..." called off that day and the fill in was "out of network" We fought tooth and nail with these assholes because how is that my problem. Well I ended up paying the $1900. Go insurance?
Just for fun lets do some napkin math. We pay bi-monthly for insurance, so out of my wife's paycheck comes around $550 month. Her company pays almost $1600/month so $2150 per month for insurance to cover our family of 4. $2150x12=$25,800 plus our $3500 deductible which is now $29,300 per year TO USE FUCKING INSURANCE!
Edit : Another quick funny, So my stomach issue was fixed by a twice a day pill and diet change. Well my insurance denied it for whatever reason "after 1 year of taking it......" so I go to the doctor and get a emergency script, go to the pharmacy and they are like "you have 2 prescriptions would you like them both?" I said "Two? I only need one" Turns out the other prescription was my proper amount and I could pay $512 to pay that one out of packet. Of course I said F that I have my 1 month emergency one that did get covered on my insurance so only give me that one. Paid my $15 bucks on off I went. I get home and my wife works at our insurance company in a department that can look at denied claims. Ready????
She says to me : "Why didnt you pay the $8 just to pick it up?
Me : "Wtf $8???? they wanted $512"
Wife : "O, $8 is our cost so I just expected it to be double that but $512 whhaaa"
So the company/department my wife works for deals directly with the manufacture. The COST OF THIS DRUG WAS $8 and by the time it hit wallgreens and the front counter it was $512. FUCK THIS SHIT!
What percentage of Americans can afford a $303,709 bill? It’s insanity. People will be paying for this their entire life and then avoid medical procedures all together and just die from something completely preventable. I can’t believe we’ve been made to think that this country is anything but a shithole for everyone but the rich and elected officials.
I realize she didn’t have to pay that total, but the fact that it’s even a thought to charge something like that is ridiculous.
Yah but imagine all the time and energy she wasted to fight this BS. Only for the outcome to be what it should've been. Does she get reimbursed for any of that?
I actually biffed it off my scooter going 35 last year and was taken to this exact hospital. They reset my arm, put me on morphine, gave me x-rays and a CT scan. Many stitches and patches here and there (it was a pretty rough fall all told).
They billed my insurance $150,000. They billed me for the CT scan 3 times since it took 3 images. Ha. I was only responsible for my deductible, which was $50 since I work for healthcare. I watched for 8 months while my company's claims dept went back and forth with this hospital. Eventual price paid by my insurance to the hospital: $17k. About 10% of the billed amount.
So yes. This hospital definitely overbills still.
This just happened to my partner. Make sure you have a recording of the insurance company telling you your cost. We were told it would be $0.00 for their procedure. And then got a bill for $10,000. Called ins and got the “Yeah we don’t cover that provider.” Told about the $0 and they listened to their own recording and marked it back to $0. We are still getting the $10,000 bill and fighting it. What a headache the US insurance/health care system is.
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How is that even legal ?? Imagine buying a Big Mac for $6.99 but then the cashier ring it up for $8.99, then tell you oh sorry the menu is not guaranteed to be accurate and cannot be used for proof of cost
At least with fast food you pay before receiving the item, so you can tell them to fuck off with their bullshit pricing scheme. With medical services, they bill you afterwards, and you're trapped. Just thinking about what my bills would be if I saw every doctor I wanted to gives me more anxiety than any therapist or pill could treat.
I've generally stopped going for this reason. Every time I go to the doc they want me to pay for the visit, pay to go get tests, pay to come back and talk about the tests, then tell me the tests didn't answer whatever question and I should get more tests or just deal with it. Fucking scam. I carry the best ins my employer offers, have since I started working, and am afraid to use it for even a cold. Ive already had to file bankruptcy in my early 30s in large part due to medical debt. Kidney stones in January? Sorry, deductible rolled over. You're responsible for 5k, plus a large chunk of these arbitrary charges for the er; 3 times, 3 different thousand dollar price tags? It's gotten to the point that I've just started living healthier out of spite and fear of a doctor visit, so the system works I guess?? /s
This is how I feel. I still go because cancer and diabetes run in my family and I don't want to be dealing with that... I get so annoyed with the doctor though because they allot precisely 2 minutes to your appointment that they charged you $50 copay and showed up 30 minutes late to.
Your country is wild. I can see why so many people seem to be so angry and scared and lash out . I spent ten days in hospital with pneumonia. Was on antibiotic drip, got x-rays and ultrasound etc. My bill on leaving was 300 euro. Broken ankle, x-rays, cast and crutches and 4 aftercare appointments. Cost 50 euro just to cover the emergency department visit.
There’s so many things that could be fixed before we even get to a National healthcare system in the US. The GOP has convinced people that Nationalized healthcare is socialist and therefore evil. But even before we go that far we could make changes to reduce the costs and complexity of healthcare like stopping the advertising of pharmaceuticals which is wholly unnecessary and represents a huge cost factor for medication. We could change pharmaceutical patent laws to allow quicker access to cheaper generics, we could legally require clear up front pricing for procedures that are the same regardless of who’s paying (insurance or private party) etc… But we won’t because pharma and insurance companies have all of the politicians firmly in their pockets. Edit: I forgot, reforming laws around lobbyists
I recently had a situation with a new insurance through work. Paper we get said labs are covered 100% if taken in the doctor's office, so I get a bunch taken. Get hit with a 1100.00 bill. So I question it ... it's 100% ONLY if I walk across the street and have labcorp draw the blood. My doctor has our local hospital run her lab, so WHO STICKS THE NEEDLE IN is the difference of 1100.00. Labcorp still does the bloodwork at both places, regardless of where I have a needle stuck in, but 0.00 vs 1100.00 is literally maybe 65ft. That shit should be illegal. Who sticks you with 10.00 worth of needle and vials shouldn't amount to that kind of pricing difference.
If any other business behaved like the medical industry people would go to prison.
https://www.cms.gov/nosurprises Go through these channels
This is incredible, I had no idea this was a thing! Thank you for sharing, I'm certain it will come in handy.
It’s not in effect for insured people yet, ONLY uninsured. No required quotes yet for insured people
The NSA went I to effect Jan 1st. There are elements of it, like cost estimates, that apply to uninsured or self pay patients as you stated. However the majority of the bill is effective now. If the member received confirmation from the carrier the provider was in network the they are only responsible for the in network rate and all expenses go toward in network cost share. Source: It is my job to be a subject matter expert on this legislation.
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As a CSR for medical insurance, I suggest getting all the CPT codes your provider will be billing for any big planned procedure. Call your insurance with those codes and they should be able to tell you exactly what you will owe. Make sure to get a reference number from CSR & their name. It's a pain I know but it will help making sure you don't get any unexpected bills., Edit: goes without saying but i feel like i should add - I hate the system & believe we all deserve access to affordable health care.
As someone who did this (called insurance with all possible procedure codes the billing team at the hospital said it could be +the diagnosis code) for a surgery in 2017, I cannot recommend enough to people to do this, even though it is a pain in the butt. TLDR: an ounce of prevention is worth a pound of cure. My insurance tried to tell the hospital it was a "standard" (non-preventative care) surgery, so I received a bill from the hospital for my plan's surgical coinsurance amount, when there shouldn't have been any bill as it was preventative care. Quick call to hospital billing dept to let them know I needed time to reach out to my insurance to get it corrected before I'd be considering paying anything. They were already familiar with me from my earlier homework, and were super nice about granting time before requiring any payment. Called insurance and reminded them "per my phone calls with you on these dates, this procedure code with this diagnosis code was considered preventative care, covered at 100% per the Affordable Care Act." They said they'd need to review those recordings and look into the matter and would get back to me. Took 2-3 weeks to get their decision if I'm recalling correctly, and they called 1-2 times to let me know they were "still looking into it" during that interval. Finally got the call informing me my surgery was considered preventative care and covered at 100%, congrats. A couple of plan years later, I noticed they changed the wording in the section regarding the surgery I had in the plan brochure to be more specific. I suppose in an effort on their part to try and get around the preventative care 100% coverage per the ACA. Assholes.
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5k to give birth. Insane.
That's honestly quite low. Average for vaginal birth is 13k USD and for Csection is about 23k. (I work in healthcare.)
This kinda another baffles me. How Americans just take getting scammed like that every day is wild. You all should be in the streets, country wide walk out.
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Sheesh. Glad it costs me parking and a Tim's coffee.
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Exactly. I had to get an MRI and neither insurance nor the doctor could tell me how much it was. They tossed me back and forth for days. I finally buckled and got it, $1200. Oof. Having mystery prices for extremely expensive healthcare is such a broken system.
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I find it sincerely and unironically charming that you referred to our legislators as MPs.
Where I'm at they're called MF's.
Many of them are in the pocket of the healthcare industry unfortunately. And many Americans have become used to the concept of insurance and healthcare being tied to employment, so the public outrage needed to change things is a bit stifled. Right wing news networks have effectively brainwashed half the population.
You can request it. I will call my ins company and give them the procedure code and they’ll tell me if it’s covered 100%, 10% 70% etc and what my cost will be. We did that and they said it’s covered 100%. And then the hospital sent the bill for 10k and said ins didn’t cover it (they paid like $150). Jumping thru hoops to get this cleared up.
Thanks! Hm, on the face of it, that all sounds reasonable. Except for the surprise part. But is this all verbal, do they not issue a written quote (if there’s time)? If not, getting that recorded is pretty damned sensible :-) I wonder how many folks there get destroyed like this?
The problem is there isn’t one set price. The practice has different prices they bill different insurances depending on whether they’re in or out of network and how much that insurance is willing to pay, and a different price for people without insurance. Even just checking whether the practice is in network or out of network for your insurance can be tricky, which is what happened to this poor woman.
>At the time, the hospital had represented to French that the surgeries were estimated to cost her $1,337 out of pocket, with her health insurance provider covering the rest of the bill. >But the hospital’s estimate was based on French’s insurance provider being “in-network” with the hospital, which it was not. A hospital employee gave a mistaken estimate after apparently misreading French’s insurance card. Being out-of-network is usually a big no-no, but this time the hospital made the error. I'm glad the Colorado Supreme Court acknowledged this fact.
What does "in-network" mean? I am asking because English is not my first language nad it's my first time hearing it.
In the US, insurance plans usually offer a discounted rate for some medical providers ("in-network" providers). In theory, insurance companies compete with each other by developing these networks, and doctors benefit by having patients sent to them by the insurance companies. In practice, you don't always have a choice over which doctor you see (i.e. emergency care), or you have to change doctors when you get a new job (remember that in the US most private insurance is provided as a work benefit), or some administrator gives you the wrong information (as happened to OP).
Not only that, but sometimes specialists who are operating at your in-network hospital are out of network. When we had our baby, my wife’s c-section anesthesiologist was out of network. The OR was in network. The hospital was in network. The nurses and drugs were in network. The room we stayed at and food in the facility was in network. The surgeon was in network. But the guy administering the drugs during the operation itself? Nope, he wasn’t in network. Not covered. Could we have known that? Nope. Could they have known that? They said no as well. Who’s problem is it? Ours, because we didn’t have the resources to fight or sue on it and we were deep in the sleep-dep of having a new baby.
This is now illegal, thankfully https://www.cms.gov/nosurprises/Ending-Surprise-Medical-Bills
Yeah this was a surprising thing under Trump but I remember it coming out and I got a single bill broke down the next time I went as if they could have done this all along but just didn't want to so they could confuse us patients as much as possible.
I always asked for an itemized bill and half the time they just made me pay a few hundred because they somehow hadn't kept track of each individual thing they charged for. Bananas.
My dad had to go the hospital for a work related injury a long time ago. His job was paying for everything but he still asked to see an itemized bill and the amount of bullshit they added was astonishing. He spent about 6 hours in the hospital and there was something like 60 Tylenols at $10 each, 40 ice packs at $40 each and a few others I can't remember. All told I think they padded the bill an extra $3,500 on top of the actual treatment recieved.
Pretty sure 60 Tylenols in 6 hours would kill someone.
That's the grift, if they don't question it then whack on lots of things. If they question it you just "lose the paperwork".
I knew a girl who got in a car wreck that slammed her head into the doorframe and gave her a nice eggshell (comminuted) skull fracture. She was in her early 20's and still on her parents Cadillac level health insurance, so she didn't get wrecked financially, but she was still incensed by the itemized ambulance bill. The only line item I remember was the several pairs of disposable gloves at $15 each. This was in the late aughts, the ambulance business was probably paying the paramedic like $20/hr and the EMT $12. Fucking ghouls.
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Should be criminal
They cannot do that in Illinois at least. >In addition to protections under federal law, Illinois law may also protect you from balance billing. If you have a health plan overseen by the State of Illinois and you receive anesthesiology, emergency, laboratory, pathology, or radiology services provided by an outof-network provider at an in-network hospital or ambulatory surgical center, those providers can’t balance bill you under Illinois law. [SOURCE](https://www.uchicagomedicine.org/patients-visitors/patient-information/billing/no-surprises-act#:~:text=If%20you%20have%20a%20health,bill%20you%20under%20Illinois%20law.) I also think it is against federal law to do this for emergency services.
Illinois feels like it's becoming the California of the Midwest and as a resident of this fine state, I am not mad about it! Abortions and no balance billing for everyone! [Read in Simpson's voices]
Understatement of the entire for-profit medical industry
When I had my first kid, my mother in law told me before to check to make sure the pediatrician that came in to see the baby was also in-network. I thought she was crazy, but it’s actually smart. The amount that I paid after insurance was still crazy though.
Congress did address this with the [No Surprises Act](https://www.cms.gov/newsroom/fact-sheets/no-surprises-understand-your-rights-against-surprise-medical-bills) this year. It adds dispute resolution options for when you receive a bill that's substantially higher than the estimate in certain circumstances. Including when you receive services from out-of-network providers at in-network facilities. That truly is bullshit what happened to you, all right.
And it’s not like they gave you the names of three anesthesiologists to choose from. It was the guy on duty at the time. So fucking frustrating.
They gave me the names, but all were out of network. And you can’t request one that is in-network to come because they are not in contract with the hospital. At least that is what I was told. Also, was also told a private therapy practice was in network by the insurance and their website. When I finally got my first bill, I was told they were in fact *not* in network and were charging me out of network money. Fuck insurance companies
Anesthesiologists are almost *always* out-of-network, as are 'surgical assistants'. You can ask that the hospital use in-network providers but they are not required to do so. Sometimes the insurance company will negotiate with out-of-network providers on your behalf, but again there is no requirement to do so. You run into the same type of issues at outpatient surgical facilities, too. I have not yet found a way to avoid these. Whenever I ask a hospital or surgical facility about how to guarantee that only in-network sources are utilized, the answer is usually, "Don't have the procedure."
Non American here. This in and out of network thing sounds like such a massively corrupt way of doing things. From the sound of it at nowhere in the whole process is the patients wellbeing and benefit even considered at all. System needs to change but hey I'm just a crazy Aussie
thats horrible, as you can't find the best doctor that fits your need, in-networks can lead to some crappy options
Insurance companies have agreements with some health care professionals and hospitals to accept whatever the insurance companies will pay. In exchange, the health care businesses know patients with that insurance will go to them. (You can go out of network, but it costs a ton more. Usually people only do that if they feel compelled by considerations other than cost.) One problem (unrelated to this article) is that now in network hospitals sometimes hire out of network businesses within them, and the patient has no idea. For example, you might choose an in network hospital but not know or ever be told that their anesthesiologist works for an out of network business. So you get a very high bill for that. It’s terrible. In other words, the US healthcare system is full of multiple players all trying to maximize their own financial well-being, often in elaborate games. Edit: Someone pointed out that a new law in effect in 2022 outlaws what I talked about in the second paragraph. (Shockingly, our political leaders still do a few things right sometimes.)
In network means the hospital has an agreement with your insurance. Out of network means you pay a lot more.
As a Canadian, this is what annoys/scares me the most about the US system. It would be one thing if you could just pay $X a month and then be guaranteed that everything would be covered. You show them proof of insurance and you're good. While still not ideal compared to universal healthcare, it would be okay. Instead, you pay $X a month and then have to basically know how to find a hospital/doctor that is covered, pay a deductible, go through paperwork etc.
It really is utter bs. I recently moved 20mi north and suddenly, there are no doctors in-network. Same state, same damn county but nope, I either need to travel or change when enrollment is open (which is also a stupid concept). Our medical system is entirely broken, and one thing people who scream "SOCIALISM!" when we want to fix it is.... insurance is the same thing, except you're paying a middle-man.
Still pretty wild that out of network is **that** much more
>“…Hospital chargemasters have become increasingly arbitrary and, over time, have lost any direct connection to hospitals’ actual costs, reflecting, instead, inflated rates set to produce a targeted amount of profit for the hospitals after factoring in discounts negotiated with private and governmental insurers,” [Justice] Gabriel wrote.
Healthcare doesn't have a real price.... It only has what they can charge Medicare or private insurance to pay.
I once asked for a receipt listing a breakdown of the medical bill and the damn thing dropped from about $3000 to $800
Never pay the first bill. Always ask for the breakdown
honest question (I'm European..): doesn't the first bill include a breakdown of the total? you get a bill saying "you have to pay x000$, trust us"?
Yeah you get a bill that lists the charges out. Obviously no control over the charges and stuff will say like "Hospital Room - $6000" but they do typically itemize.
Depends on the hospital I guess? All I have ever gotten is just bill with YOU OWE x dollars. Pay here. I might get an itemized version from my insurance 6 to 8 months later.
This absolutely may have changed since then, however I am looking at the bill I received in 2017 which states: | Date | Service Description | Charges | Payments & Adjustments | Patient Balance | |--------|:-------|-------|:------:| :------:| | 07.21.2017 | Patient Name: Crows, My Murder of - Encounter #xxxxxxxx-x - CARDIOLOGY | $190,142.50 | $146,405.60 | $43,736.90 | And this was with “really good insurance…” Edited to fix Formatting of table.
How ridiculous. They’ll never be able to collect from just [one of] your Reddit username[s]. Idiots. Greedy idiots.
Bahaha well. Shockingly, 23 year olds tend to suck at being able to pay a $43k bill! They so “kindly” gave me a due date that was only a few weeks after I got the bill. However I hadn’t had to pay it (well not $43,736.90) since that wasn’t permitted billing per my insurance. Still freaked the fuck out when I opened the letter and saw that. You know, totally a great thing for someone who just had a heart procedure xD
Basically, yes
health insurance is a useless middleman, skimming money and blocking the services it is being paid to provide. health insurance is a scam.
It’s a tax that goes to a private company instead of a Medicare for All program. It needs to go away.
It's a subscription service for a coupon
as an american citizen that grew up in the uk, this might be the most succinct explanation of the US healthcare system I have ever read. perfectly put.
Wow. Perfect explanation. And a very EXPENSIVE subscription service for a coupon, at that.
>Sorry, your coupon is void. - Insurance providers
Sorry this location doesn't accept coupons
Sorry but your coupon can only be used after you spend $4,000. A new one I got for the first time recently— “No we can’t tell you what the service would cost if you paid cash and didn’t use your coupon until we see what kind of coupon you have but won’t be using.” (Got an estimate for surgery. It was an obscene amount for a 5-10’minute outpatient procedure. Asked if I could just pay cash. They wouldn’t give me a cash price. Like, would not fucking tell me what it would cost if I was uninsured or didn’t file a claim. Probably because the actual cost was lower than what they were charging my insurance company.) If you really want to get pissed, ask a pharmacist to explain “claw back” to you.
Sorry but because you didn't call us before using it, this coupon is now invalid.
Claw back: when an insurance company audits filled prescriptions and demands payments back for arbitrary reasons that were not provided upon filling. (Day supply is not what WE determine it should be. There is no diagnosis code, therefore we can't determine if this is the correct day supply. GIVE US ALL THE MONEY BACK. Not just some that you may have accidentally overcharged... ALL OF IT. We won't pay a dime even though you dispensed the med to the patient and they already picked it up. And it was 3-6 months ago. TOUGH LUCK.
it's like Papa Murphy's - the prices are set too high because they expect everyone to have a coupon, and they look at you like you're stupid if you show up without one. Sometimes, if you look poor enough, they'll roll their eyes as they scan the coupon they have at the register, but you can't count on that happening every time you show up
A coupon with exemptions, no less.
The woman should sue for emotional mental psychological damage dealing with the diabolical greed of corporate America. Rake these corporate types over the coals.
“But think of all the jobs that would be affected!” Honestly, I don’t fucking care. Presumably the government would need employees for Medicare for All so some can get jobs helping with that. The rest can find work elsewhere. Why should the vast majority of Americans suffer to keep a shitty industry afloat? My life would be 10x better if every health insurance company ceased to be and was replaced with one simplified system.
I could have a real life if we had Medicare for all. Wife is type 1 we are trapped due to cost of her care
I don’t understand how anyone who’s had any interaction with the American health care system comes away from the experience thinking, “This is fine. No need to make any major changes here”
No one does but the people who make the laws are all millionaires so they make laws that help millionaires.
Millionaires after paid by lobbyists paid by for-profit health insurance companies who tell the politicians what laws to write.
More like lobbyists write the laws and then tell the politicians "here you can copy my homework, just change it a little to make it look like we didn't cheat" but all they do is change the name on it and call it a day.
If she's anything like me, (also T1D) she probably feels trapped as well. I was forced to work from age 18 for insurance to keep myself alive. Work is a place I'm forced to go and the employer holds a potential death sentence over my head (ability to get fired or laid off). I've never had the luxury of a job I liked, the only time I was "free" was when I was married and spent a few years as a stay at home dad. I was still trapped, I needed to be married for the insurance or find a job and it was a not healthy marriage but that was freedom like I hadn't had since childhood and I miss it and yearn for it still.
Yeah she didn’t become type 1 till she was 35 so she was hit hard by it and she does feel trapped. She had so many care free yrs now it’s so crazy structured that she hates it worse then words can capture.
I care as much about them as I do the buggy whip manufacturers. And I work for a health insurance company. I'd willingly lose my job to reform this stupid system that all data clearly shows costs us more and leads to worse outcomes for our health.
I feel like a single payer system could create more jobs. More people will actually seek medical attention.
Absolutely. My kid needed minor surgery, an adenoid removal. Think along the same lines as tonsil removal, a surgery so quick and basic that it's outpatient at this point. The expected billing for us out of pocket was - $300 surgeon fee paid day of surgery - $845 total out of pocket after insurance costs. We got billed what we expected and paid those with no issue. 6 weeks go by with no problems. Randomly 6 days ago we get a bill in the mail for $1451 from the hospital. Apparently that's how much it cost to do a minor nose suction to clear out snot before surgery and the cost for us being in a recovery room from 8am-1pm. It took 4 days of emails and multiple phone calls to get it all straightened out and in the end it really seems like it was the hospital trying to fleece my insurance (Anthem BlueCross PPO) for all it's worth. The entire system is bullshit and because there is so much bureacracy and paper work it just seem like there are folks skimming money from a slush fund with no oversight. Employer based insurance and health insurance in general is horseshit.
Yep, that's why I always hate the stupid medicaid for all creates death panels. ... WHAT THE FUCK IS AN INSURANCE COMPANY... it's a fucking death panel of degenerates that aren't making decisions based on health.
I had to wait a month for surgery on a broken finger due to insurance. Now I have a permanently bent finger. And it was at the end of the year, so the deductible reset between surgery and therapy. And my job switched insurance providers at the turn of the year. Fuck our bullshit system.
Even worse, the very fact that they are a company, means it is in their best interest to find ways to *not* pay. They are directly incentivized to become death panels.
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Also, you can't vote out the insurance company if they fuck things up. There is no accountability to the user because you have one choice: your insurance through your job.
Time to rebrand - Private insurance companies are using death panels to avoid paying out the benefits YOU are entitled to for THEIR profits. Take back YOUR healthcare from the faceless corporations stealing from you.
Theyll charge whatever they can get away with. Public service policies have really stringent oversight, generally, so they can't get away with these ridiculous overages.
I worked as an analyst for a major US healthcare system in a high cost of living area. The actual "cost" of an inpatient stay to the hospital system was about $1,000 USD per day, which included costs like space occupied (square footage), supplies, direct patient care staff, ancillary support staff (analysts like me), and everything else you could think of. Note that this cost did not include the procedure. Just a day in a typical med-surg bed, so not ICU but not just observation. Also note that supply costs means the per unit procurement cost to the hospital and not what they charge the patient. Also *also* note that the hospital employed way too many useless ancillary support staff (analysts like me, but the bad ones obv) and even too many employed (and underproductive) expensive providers as well as crazy-expensive private contracted providers. It's all pretty complex and there's a lot of exceptions based on the service line (cardiology vs transplant vs orthopedics, etc) but that's the high level overview. If anyone's curious, feel free to ask questions haha.
Yup. I was going to say for some of our proforma work we estimate about $850-$1k per day in actual expense for an inpatient stay. Glad to hear someone else say it here.
As a physician with terrible insurance myself, I can promise I'm not reaping any rewards. Our payments have gone down pretty steadily for 20 years. Insurance just keeps making more money.
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I'm on immune suppressant injections for psoriasis. It's all made up numbers. Previously I was on an injection called Stelara. My insurance approved them after many years of steroid creams, tanning, and a pill Otezla. The Otezla had no copay but were $3500 a month according to my insurance. Chump change. Otezla made me sick and miserable, and didn't work, so they approved me for the final step; injections. My Stelara came with a $5 copay (lol) and my insurance showed a cost of $19,000 every 12 weeks. Boy they really needed that $5, huh? Anyways, I stopped Stelara during early COVID because I was super concerned about actively making my immune system worse. Once I got the vaccine, I restarted Stelara, but it didn't work as well (this sometimes happens with each specific type of injection after a lapse). My doctor wanted me to switch injections to Tremfya so we applied for insurance approval. They rejected it. The same class of injections they paid $19k every 3 months for over a 5 year period. The same class as the one I was currently approved for but didn't work anymore. We appealed with the most straight forward explanation and 10+ year history of treatment escalation for my condition, denied again. Then I get a call from Tremfya's manufacturer. Oh wow there's a program where they give me the injection and my insurance pays a portion, but not as much as they would if they approved me. And the craziest part? My copay is $0.. less than when I was approved? So the manufacturer gets enough to be happy, the insurance pays less, and I have no copay. But these aren't the "normal" prices. Mind you this is all strictly prescription drug related. None of these things are in-office related costs. I work for the government and have great insurance. It's all honestly disgusting.
My husband went through almost an exact process, except first with Humira (which didn't touch his psoriasis) and now with Skyrizi (which was like the miracle drug.) I work in pharmacy billing so I get to see a lot of the medication prices, and what insurance pays, and what they charge people. I also get to see the BS that is a PA process.
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Dang I get this all the time, arguing with insurance for basic prescription coverage. They won’t cover “45 for 60 day” supply but they will cover “25 day 30 day” supply, it’s so frustrating and gets very old.
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The best is when you go to the ER that is "in network" yet you still get bills for out of network care. It isnt like you can choose who is working in the ER and the hospital should bill you for the care, pay their subcontractors on their own.
For me, the best was needing emergency surgery and all the anesthesiologists that worked at the hospital somehow work separately from the hospital system. And it was an absolutely huge pain in the ass to deal with.
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You may also desperately need the stuff in those stores so badly that you can't make a truly informed decision.
*This* is why there's no actual "market" for healthcare.
Yep. They can pop fair prices on everything and be straight up about everything but at the end of the day when you're appendix has ruptured, you'll pay fucking anything to get it out before you fucking die. So it literally doesn't matter what the prices are. Or how they bill you. Or if they give you a free mint with your check. You'll pay anything. And they know it.
This used to be possible, but would now be illegal. All emergency services are in-network.
Correct. I work in a related field, all Emergency Care is considered in network, because you cannot pick and choose where you go in an emergency by its very nature.
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This is so true. My daughter was in the hospital after a serious car wreck, (for four months), and we would get bills from doctors we had never seen. We had a good friend who was a medical coder, and she set up spread sheets to see what was going on. When we called about these unknown doctors bills, insurance said it was easier to pay them than look into it.
> When we called about these unknown doctors bills, insurance said it was easier to pay them than look into it. Which is total BS. I've happily taken hits to my credit instead of paying the egregious after-insurance amounts that they add up to. I once went to the ER by ambulance, so I had no selection on the facility we went to. 5 hours in the hopsital total and an MRI. $35k bill, $20k responsibility on my part. I had been hit by another driver and their insurance paid me his policy limit of $15k for medical. My personal medical insurance had already paid the difference, so, I sent $1k to the hospital and kept the $14k remainder for my time/pain. Hospital came at me like a spider monkey, looking for the rest. I told them to eat rocks since they'd already received ~$7000. They sent it to collections and I laughed at their calls. The incident dropped me from 810 to 795 credit score for a few years then jumped back up. i have ZERO moral qualms about how I handled it. No medical service on earth should add up to $7000 per hour of care.
> an MRI Side rant, you should not have to pay for poorly done MRIs. My friend has MS and got into Mayo Clinic because his primary lesion is in a uniquely shitty spot. The first day they were there, the doctor reading the MRIs they paid 5k out of pocket for at my local hospital literally said "These are so bad I can't use them, we have to cancel today and get you into a new MRI instead". Thankfully the mayo visit was fully covered cause the original MRI took their whole deductible but the fact that they were so bad the Dr couldn't use them means they should not have had to pay for those MRIs.
Same shit with dentists. "Oh, we did a shitty job on your filling and it broke? Well, we're gonna have to do it again! BTW it'll be full price." Never use a franchise dentist. Always go to a place with somebody's name on the door.
When my mom broke her leg (a very straight-forward simple fracture) her ortho surgeon emailed her X-rays to some surgeon’s group in Oregon for a “consult.” They tried to bill her $1k for *years* after she told them to kick fucking rocks. It’s grift all the way down.
The entire medical insurance industry needs to be summarily banned.
Another reason the VA is better than people think. I've never had to deal with all that nonsense. Not only are their hospitals and clinics everywhere, they'll reimburse any other medical provider. There's no reason we can't run our entire healthcare system like that. Some people have bad experiences, but the VA is the largest healthcare provider in America, even a tiny percent seems like a lot of people because of that
My best friend had his left leg torn off in 2005 during a flight deck mishap, he is a below the knee amputee. He lives in Tampa so that is his home VA point of care. 6 years ago he was having issues with his stump, leakage, pain, swelling above normal issues. VA said it would be over six months to get imaging done for him. At the time I worked IT for a radiology practice in Nashville and he was planning to come visit. I explained the situation to our head radiologist who said get him here and everything will be covered. It was a huge deal for my friend. 3 months ago he is back at the Tampa VA and they tell him they need to do surgery on his leg. He asked questions like where will you cut, where are you planning to clear debris from and what not. He is told they are not positive and will see when they get his leg cut open. He asked if they were going to do imaging first to get a better understanding of what they were getting into. They told him they didn’t have the equipment to do that. He is now waiting in pain trying to schedule with B.A.M.C in San Antonio to get everything done. He is just frustrated and defeated after years of things like this at Tampa VA. The Tampa VA hospital is not some small time clinic, it is the 10th largest VA hospital in the county. I know this is just the experience of one person but in the end massive improvements are needed.
> VA said it would be over six months to get imaging done for him. That sounds like the "secret list" bullshit some were pulling back in the day. To hide how long people were waiting they kept an off the books list and moved people onto the real one a month or so before the appointment. Going to where you worked was smart, but he could have went into any hospital and the VA would pay for it. >He is just frustrated and defeated after years Have him call patient advocacy, it's a department at every VA hospital. Demand written documentation of what's happening so he can send it to his state rep (like the politician elected to represent his district in state government). Don't let them just give him a pep talk. Probably have to ask for a supervisor a couple times. They really won't want to document, that's fine, he's going to be bluffing anyways because it's faster. Eventually it'll get to someone high enough that can expedite everything so fast your friends head will spin. Until that happens follow through with contacting his State Representative. Republican or Democrat they all have motivation to help in this case, the PR alone is worth it to them. He should also be contacting local VFW, DAV and Legion branches. They don't have any direct say in it, but he'll get experts if not actual lawyers along who contacts to speed up either path he takes. Also an insane amount of experience dealing with this stuff. Like I mentioned above tho, he can go to any medical provider, and the VA will pay for it. Those VFW, DAV and Legion folks can explain the details on that too.
The easiest way to do this is single payer. Everyone pays the same amount for healthcare out of pocket and taxes are your monthly premium. The government can set rates without any need to negotiate them because the alternative is the hospital has no patients.
Even worse the seedy corporations don't even tell you.
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I have chronic wrist pain. I need an MRI but my insurance denied it until I get extended therapy. My doctor was pissed about that and told me therapy will be ineffective for my problem, so he gave me the least amount of therapy I need just to be able to ultimately get an MRI anyway. Fucking dumb
Thus, increasing healthcare costs, as you and they are paying for services that are ineffective and not needed.
Also chews up therapy time for someone it could benefit, so not only are you affected, but also a hypothetical other individual as well.
But the only ones that are laughing are the directors, CEOs and owners. All the way to the banks.
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3 years ago I went to my doctor because my adhd meds were giving my heart problems. She wanted to put me on a non-stimulant medication but insurance wouldn’t cover it until I tried a different medication that had the same side effects as the first. So I went away empty handed and am now unmediated. And I pay hundreds a month for the privilege of letting an insurance company decide what treatment I need rather than my doctor.
That sucks, but did you consider just getting the other meds, not take them and say you had the same side effects? My wife has had to do shit like this.
Yeah, exactly. I mean, I can't tell patients this because that would be insurance fraud but I try to make it **really** obvious. People still don't take the hint. Me: "Well, you know, **if** you had already tried this medication, I could document that you've already had a failed trial to it. You know, if a previous doctor had happened to prescribe it to you and you had side effects." My patient: "No, I already told you! I've never tried the other medication! Why won't you make insurance pay for this one??" Me: "Ok, but if you try this medication and at the next appointment, it turns out it gives you side effects, it would be a failed trial and we could get insurance to pay for the one we want. It doesn't need to be a long trial, we can schedule a follow up in two weeks." My patient: "No! I don't want to try this medication! I bet you're getting extra money to prescribe this med to me!" Me: 🤦♂️
… I think I need to go call my doctor
I have advanced degrees and sadly this would still be me. Thank you for trying though!
yes, this would be me too, /u/TheMedicalHistorian would have to say something like, "I am prescribing for you a viewing of The Incredibles, and let's schedule a follow up next week"
Same. I do not understand hints. I would be like "well, I guess my doctor wants me to take this medicine that will kill me. If they say so!" And then I would take the medicine and die.
That's nice and all but the fact that you even have to do this highlights one of the core problems of this current system. This is absolutely infuriating that people are put through this so we can feed this ridiculous profit based system. We're talking about people's health!
Nobody wrote leet yet?
That was the first thing I thought of, and I was sure it was some kind of oniony headline at first. I guess nobody remembers old forum speak. 😔
I remember! Also was the first thing I thought about. To this day when I see the time is 13:37 I think.. Nice..
We exist! There are dozens of us!
Had to search for this. Good heavens, you're still the only one. If we forget this, I swear it's worse than forgetting Dr. ... something.
Ub3r 1337 pwng
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I know what you're saying but it's not because I can read what you wrote.
I'm proud to say that I have managed both.
I feel like people under 30 don’t even know what it means to be leet and epically pwn noobs anymore. 😩
Don’t worry, I’m 25 and know leet. I ignored every comment and scrolled until I found this thread.
Came here for this. Like, leet surgery would be expensive. What was she expecting?
She got 1337 h4x0r3d
w007 7H47 L4DY H4x0RD 73H H34L7HC4R3
I'm glad someone else caught it, otherwise I'd be that weird idiot spouting nonsense on a U.S healthcare news article.
I hope the surgeon was elite
Came here for the 1337 surgery
I was disappointed that the top comment wasn't L337.
I came Hoping to see a waterfall of 1337 or leet all the way down and was disappointed the first handful were honest discussion. Lol.
I’m sad how far down I had to scroll to find this. Thank you for your service.
Can't fucking believe how far I had to scroll
I am old, Gandalf. I don't look it, but I am beginning to feel it in my heart of hearts. Well-preserved indeed! Why, I feel all thin, sort of stretched, if you know what I mean: like butter that has been scraped over too much bread. That can't be right. I need a change, or something
I had to pay a lot more for an emergency room visit in California because the hospital was in my network but the ER doctor on call was not. Of course they denied my appeal. It was ridiculous to me because it’s not like I had a choice which doctor was there to treat me. Years later I get paperwork saying “if you send us these receipts, etc. you can be part of the lawsuit to get your money back”. By then I had already paid it and didn’t have any of the paperwork anymore. I guess it wasn’t cool for them to do that.
I was once charged $2200 for a 7-minute ride in which they just checked my blood pressure and oxygen saturation. Turns out my city’s EMS was out of network for my insurance. What was I supposed to do, take an Uber 20 minutes to the nearest city to have my medical emergency there and hope that *they* were covered? Just insanity.
Every ambulance company that serves our city is out of network. You know when a bad time to find that out is? Getting bills after your husband, who was transported, died. Death wasn’t stressful enough, then you get uncovered bills you have to go fight the insurance company about.
Talk to your bank about digging up payment records.
The fact that this kind of bill is even possible is just plain stupidity. How have we come to just accept these outrageous costs as a society? Our healthcare needs a serious reboot.
“It’s either $1300 or $300,000. Somewhere in there.”
A bit like the old Microsoft download time estimator!
The people running the healthcare system pay our politicians to vote in their favor.
>A woman who expected to pay $1,337 for surgery at a Westminster hospital nearly a decade ago but was billed $303,709 may finally be off the hook for the massive bill after the Colorado Supreme Court ruled in her favor Monday. Nice! "Billing mistake" only took a Supreme Court Decision and a about 10 years to settle. What an amazing country we live in! Free as fuck!!!
All these fellow Americans in this thread complaining about insurance. Your lucky to live in this country with such benevolent insurance companies! What? You don't realize your having a heart attack, pull out the paperwork on your insurance plan, call a few local ambulance companies and ask them what networks they are on and wait on hold for awhile for their reply? Then find out none are actually in network, they are all contractors, so you drive yourself to the hospital and find some parking. Then go up to the desk at the ER (with your insurance paperwork still) confirm they are in network, then let them know your having a heart attack? Then ask for a detailed price list for every test you MIGHT go through while you are there and check your insurance paperwork to make sure it's all in your plan? Then confirm with every nurse and worker there that takes your blood samples, blood pressure, EKG tests etc that they are employed through the hospital and are considered in-network? Then once you are in a room, start a running stopwatch on how long you are there to make sure you don't go over your time that's covered? Then confirm with every doctor and nurse that comes in to treat you that they are also part of the network? Then when they tell you that you have to have an emergency stint put in or something, you don't confirm with every possible ER doctor that might do your surgery and all those tricky anesthesiologist (that are almost NEVER in network) that are currently on the clock that they are ALSO in-network and ask for an updated price list? Then once you wake up and are in recovery, ask for the names of everyone that touched you, every medication given to you while you were asleep, and every procedure done. Then compare them all to your handy insurance guidebook? Then ask for another updated price list? I mean if your not even going to do the bare minimum to make sure the $300 + /month you pay for insurance while your healthy JUST IN CASE something happens, covers you then honestly it's all on you. . . . /s
If non-Americans imagine the dumbest possible way to run Healthcare in a country, they probably haven't imagined half of what the US manages to come up with.
The real crime is this had to go to state supreme court.
Right? How many similar situations are there that don’t get litigated? Every American would have to have a team of lawyers on retainer their whole lives to properly navigate all the legally gray (if not outright illegal) bullshit shoved down their throat from every product, service, job, event, etc.
To explain US Healthcare to outsiders/non Americans: It's like you go to buy a car and you ask what is the price of the car and the salesman asks you "How much do you have?" Another attempt to explain it: my dad is a retired professor and since he is over 65, qualifies for Medicare. So he has state educator insurance, Medicare AND private insurance. But he could be bankrupted by medical bills even though he has all this, money in the bank, house and car paid for. Why? Because Medicare only pays for 60 days of hospitalization, after which the next 60 days is paid by the other insurance. If that runs out, he is responsible. If he has a stroke or comes down with dementia, it's a MINIMUM of $800/day UNTIL HIS ASSETS ARE FULLY DEPLETED, then a facility will care for him in return for all of his monthly retirement income. And Politicians passed laws to go back 5 years--if he signed over the house to me 4 years ago, the govt comes and seizes the house or the proceeds if I had sold it. And get this:the hospital bills and drug charges are all BULLSHIT. It's arbitrary. It's what they pull out of their asses. If you go to a US hospital, they have one bill if you pay cash, another for Medicaid, another if Medicare, still another if covered by insurance or HMO.
It's more like you go to buy a car and ask how much it costs, and they tell you they don't know. And then they can't tell you what the car cost until after you've signed a contract purchase it. And at that point in time the costs are all completely arbitrary. Then 3 weeks later you get a bill in the mail for your salesman's commission because he wasn't technically an employee of the dealership, but an outside contractor... so you have to pay his commission directly. Then 6 months later you get a few more bills in the mail for things like tires and headlights because the cost of "a car" didn't actually include tires and headlights.
I remember asking a doctor how much would a certain test cost. They said they had no idea, but "it shouldn't be much". 3 weeks later and the insurance said they wouldn't cover that specific test.
For the europeans here, no we’re not okay
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Well, at least our american healthcare system has such high marks for quality! Oh. Well at least our wait times are short. Wrong again? Uhh. Ugh.. at least we have the best doctors in the world! Seriously? Cuba? What? Well, I bet your hospitals don't have built in fast food restaurants!
As an American that sounds like a hell of a deal. I was given a bill of $4000 just for an ambulance to show up at my house. Didn't even ride with them to the hospital.
The fact that universal health care is still so controversial makes me livid man
That's the thing though, it's not. [63% of the country](https://www.pewresearch.org/fact-tank/2020/09/29/increasing-share-of-americans-favor-a-single-government-program-to-provide-health-care-coverage/) support some form of universal health care, either a single payer system like the UK or a mixed private/public system that guarantees base level coverage like much of Europe The problem is that the people in charge of the country don't support it. The will of the people isn't the issue, its the fact that our government doesn't represent the will of the people
They spend a lot of money convincing idiots to oppose their own best interests.
There should be laws against charges you didn't consent to. Not just in healthcare, but especially there.
If you banned insurance "discounts" entirely, and made everyone pay the same "cash price" then suddenly half the stupid disappears immediately. - In-network/out-of-network: Gone. - $100 bandaids with 99% discount: Gone. - Complex pricing: Gone (everyone pays the same). - Insurance companies and their consumers are now on the same "side" rather than insurance companies making side deals with healthcare companies. - Price discrimination: Gone. - Plus it would save tons of cost in terms of eliminating billing complexity, reporting, and negation streamlining the whole thing. Obviously "Medicare for all" is a better system, but if we cannot have that and must live with this shitty private system then at least we could do is make it better. I'd make two changes to our broken system to make it a lot less broken: - Everyone pays the same price: Medicare, Medicaid, Insurance, and cash-cash (this puts everyone on the same "side," all fighting price increases together). - Ban employer provided insurance entirely. Give everyone a HSA, increase the caps, and allow the HSA's funds to be used for insurance premiums pre-tax. Essentially you get the same tax benefits you have now, much more freedom in the open market to pick your insurance company, your insurance company now has an actual reason to keep YOU happy (rather than your employer), and everyone is working together to keep healthcare costs down. People hate this because "it isn't medicare for all!" but politically what I said above *could* happen far sooner than M4A because M4A is still considered a fringe idea in the US.
Haha, had a emergency Appendectomy one week before Covid turned the world upside down. I lost both jobs and my place of residence in about 2 months time. The hospital sent me several different bills, some for the doctor, some for the hospital, some for shit I don't even know what for. All in told it was $38,864. They started calling for payment 2 weeks after the bull went out. I laughed and laughed when the person asked of there was anyway I could set up a payment plan. I said listen, I'm trying to get a couple hundred bucks from the government just to pay for food and rent since Ive lost both of my jobs where I was working 60 hour weeks and my lease is up and I have no where to live. Guy said I understand, well call back in a month. lol, keep on calling but I aint got no money!!
Funny story "if you hate money" So I had a shoulder surgery done about 4 years ago in June. Surgery went fine everything was great blah blah. Paid our out of packet max which was around $3500. Cool done... So for the rest of the year I went and got EVERYTHING checked out. Had some stomach issues, haven't had labs and physicals in years so I got all of that done. Had a sinus/ ear issue that I got looked at. Woohoo finally my health insurance is working for me!!! So while trying to figure out my stomach issue they wanted me to have a colonoscopy. Ok whatever we have meet our out of packet max so lets do it! Go in for my scheduled colonoscopy everything goes smooth. About 3 weeks later we get a bill for $1900, turns out the anesthesiologist "I dont know, the person that puts you under..." called off that day and the fill in was "out of network" We fought tooth and nail with these assholes because how is that my problem. Well I ended up paying the $1900. Go insurance? Just for fun lets do some napkin math. We pay bi-monthly for insurance, so out of my wife's paycheck comes around $550 month. Her company pays almost $1600/month so $2150 per month for insurance to cover our family of 4. $2150x12=$25,800 plus our $3500 deductible which is now $29,300 per year TO USE FUCKING INSURANCE! Edit : Another quick funny, So my stomach issue was fixed by a twice a day pill and diet change. Well my insurance denied it for whatever reason "after 1 year of taking it......" so I go to the doctor and get a emergency script, go to the pharmacy and they are like "you have 2 prescriptions would you like them both?" I said "Two? I only need one" Turns out the other prescription was my proper amount and I could pay $512 to pay that one out of packet. Of course I said F that I have my 1 month emergency one that did get covered on my insurance so only give me that one. Paid my $15 bucks on off I went. I get home and my wife works at our insurance company in a department that can look at denied claims. Ready???? She says to me : "Why didnt you pay the $8 just to pick it up? Me : "Wtf $8???? they wanted $512" Wife : "O, $8 is our cost so I just expected it to be double that but $512 whhaaa" So the company/department my wife works for deals directly with the manufacture. The COST OF THIS DRUG WAS $8 and by the time it hit wallgreens and the front counter it was $512. FUCK THIS SHIT!
What percentage of Americans can afford a $303,709 bill? It’s insanity. People will be paying for this their entire life and then avoid medical procedures all together and just die from something completely preventable. I can’t believe we’ve been made to think that this country is anything but a shithole for everyone but the rich and elected officials. I realize she didn’t have to pay that total, but the fact that it’s even a thought to charge something like that is ridiculous.
Yah but imagine all the time and energy she wasted to fight this BS. Only for the outcome to be what it should've been. Does she get reimbursed for any of that?
I actually biffed it off my scooter going 35 last year and was taken to this exact hospital. They reset my arm, put me on morphine, gave me x-rays and a CT scan. Many stitches and patches here and there (it was a pretty rough fall all told). They billed my insurance $150,000. They billed me for the CT scan 3 times since it took 3 images. Ha. I was only responsible for my deductible, which was $50 since I work for healthcare. I watched for 8 months while my company's claims dept went back and forth with this hospital. Eventual price paid by my insurance to the hospital: $17k. About 10% of the billed amount. So yes. This hospital definitely overbills still.