That has included me, in the past. It is stupid easy to accidentally have a debt to a hospital. For families, sensible privacy rules at clinics can mean that it is very hard to choke point bills to a single person. To the point that I asked every time if I owed money when I did checkups to be told that we did not. Only to later find that my family did, in fact, have a bill due. For a while.
Recently I'm getting it with the stupid "anesthesia is billed separate from the surgery" nonsense. At least this time I noticed the bill. Why is that not a single bill, though? Imagine having to pay the cook, cleaner, server, and attendants all separately. So frustrating.
One thing my mom has been dealing with recently is where the insurance EOB and the bill differs substantially. My mom called the hospital to ask for an explanation and poof the bill is magically lowered by a several hundred dollars.
How the heck is this not criminal fraud? Why are people allowed to simply bill whatever they feel like it, and why is my mother getting 'balance billed' for random amounts? They're still doing all this dirty underhanded stuff and when they get called out on it, it's 'Oopsie! Our mistake' when they know most people they do this to will naively pay it
Yeah, they play this game enough that I simply question fucking everything. They will explain every single line item in a way that I can map back to a timeline, or they will take it off.
This has to be done in person, where they can't be, uh, accidentally disconnected, but I've found the rate-of-return on that time hard to beat. They discover all sorts of "mistakes" when you're taking up their billing specialists' time.
It is a bit like haggling over your car price after you already bought it; the main thing to get over is the social discomfort of being a pain in the ass, so they can't use that against you.
I had major emergency surgery a couple years ago. The hospital sent me a bill for $9k (out of $135k total) after a few months but the status on my insurance website indicated they were still figuring it out.
I called and asked how they had arrived at the numbers in the bill and the person on the phone basically told me "it looks like someone just guessed, go ahead and ignore the bill and we'll send you a correct one later."
(Resolution: Thankfully I had excellent health insurance at the time. I think I paid a few hundred bucks to the surgeon and that along with prior expenses filled up my yearly out-of-pocket maximum. I never saw another bill from the hospital)
It probably is; however, it's probably also not being enforced, since no government agency in the US seems to have the teeth or the will to protect consumer rights to the level they are elsewhere.
Also, when they do get a bit too willing, their regulatory activities get shut down or their funding cut because they become a little too visible in the public eye (who has a negative view of government agencies and federal employees in general). Very few government agencies have the courage to take actions that might end up on Washington Post etc.
Depending on the state you are in, balance billing can be outright illegal, and, in many cases, despite facilities potentially trying to get you to sign a waiver against your protection from balance billing, that right can't be waived except in limited circumstances.
From what I’ve experienced, having an open dispute doesn’t prevent healthcare providers from sending you to collections and permanently ruining your credit.
its not nefarious - most likely the patient statement printed and sent before someone corrected the coordination of benefits (i.e. right insurance, right copay etc), usually triggered by you.
So you got a paper that was outdated, that's it.
Its actually typical for a patient to have a huge balance, then get sent the amount, so the patient has ownership of the problem. That usually results in patients calling and correcting whatever error they (or staff) made that made balances ballon.
Unfortunately, as long as everything including a paper cut is supposed to be covered by a regulated health plan, that's what we are going to get.
All you can eat tends to increase the cost to provide it, if someone else is paying for it.
'Outdated', funny when my mother asked the hospital what the current balance was, that figure was automatically quoted. When she then asked for a breakdown of the charges, they said they'd 'have to get back to her' and then called her later with the new amount.
I'm of the strong opinion that the US healthcare system should join the developed world and go single payer. The system we have was clearly set up to exploit patients.
I've been getting those separate bills recently and it's driving me nuts. For one small out patient procedure I have received bills from the hospital, the doctor, the anesthesiologist, anesthesiologist nursing company, and a random surgeon I have never met that the doctor asked in for a 30 second consult (I know how long the procedure took) while I was under. Seriously considering ignoring some of these whotf-are-you bills out of spite.
I'm surprised medical billing scams aren't rampant, considering it's 100% normal to have a bill from from an unknown company show up asking for payment for unclear reasons for a procedure done a year ago.
> I'm surprised medical billing scams aren't rampant, considering it's 100% normal to
The difference between honest-to-god scams, and just these meaningless me-too bills that accompany every medical procedure or test... well, is there a difference?
If a scam is some scheme or trick to get you to pay for something you never agreed to pay for and wouldn't agree to pay for if it were said up front, through deception strategies like opaque policies and maneuvering you to a point where you can no longer back out of it...
Then pretty much all of it is a scam. That the people performing the scams have professional degrees in medicine, that they're gainfully employed as hospital and medical company employees, and so on, that doesn't really change the nature of it.
Originally, the "scammy" behavior was developed (and not deliberately) to try to coerce the insurance companies into paying. But the insurance companies could afford employees to counter all those tactics. This didn't mean the experise was wasted though, they simply turned that onto the patients themselves.
The crazy thing to remember is that none of that expertise will go away, no matter what happens. Maybe they'll turn it on the government too, at some point, if we ever get universal healthcare. That could be a hoot, couldn't it?
They are rampant though. Been in the medical system for the better part of a decade and after every hospital visit, I have to call the hospital to verify each bill I receive. At least 20% of the bills mailed to me are fake.
> Seriously considering ignoring some of these whotf-are-you bills out of spite.
Then they will sell your debt to a collections agency who will make it their business to harass you to the maximum extent legally allowed (and sometimes more than that). This may include impacting your credit score - although I think some states at least have protections against that.
there is a company where you can submit your bills if you suspect overbilling. they have professional coders on staff and they will find fraud or overbilling on your behalf and also sue the hospital too
medical billing fraud is a serious offense that can get the hospital in quitw hot water and they leverage that
I had an issue with an ambulance bill that was billed separately from everything else. Despite me being conscious, handing them my current id - they found an address from 2+ year prior - so I never received a bill until the collections notice.
I spent the better part of 5 years resolving it; I got them a check from my previous health insurer at year 1 when I got the notice, but since they had already sent it to collections - and I had denied the debt they never removed it from my file; then they changed billing 3rd party providers. So i spent 4 years calling once a year -- until I called an administrator for 2 weeks straight until she got fed up and fixed it.
I agree this is so frustrating. One thing that I’ve found in the US is that in addition to having fewer out of pocket costs, being on an HMO plan can significantly simplify billing vs a PPO plan. We switched over to an HMO plan from PPO during my wife’s pregnancy and we went from getting a new bill in the mail every week to just paying a fixed co-pay at the doctor’s office every visit. It saved us so much stress, and in our case we were able to keep the exact same doctors, facilities, etc. We also saved a bunch of money, but the simplicity ended up being the thing that I valued most.
Years after our child was born, I ended up getting a scary letter from a collections agency. Turns out I had missed some $20 bill from the time when we were on the PPO plan. So they say, at least - it seems equally plausible that it was a billing error on their side (of which we found many), and they never once mentioned it during any of our visits. But at that point I was not willing to fight over $20 and just paid it.
I, and my family, are now literally asking on every single thing, "Is that covered by my insurance? Will I be billed extra for that?" Like, over and over. Stupid system, stupid questions. At a recent minor surgery I must have asked it 10 times, and once for these little grippy socks they wanted to give me for my bare feet. And yup, they cost extra. So, get 'em out.
Not in network is something that I'm facing in my country despite "universal healthcare".
You have to go to a website to find out if the hospital or clinic has a contract with your insurance company.
Same. I about lost my mind when I was hospitalized, given a wrong diagnosis, and then received a bill from the hospital, provider, and the lab in separate bills. At the time it felt like it would never end. The worst part is it doesn't feel like they really have a cap on the time they have to get their shit together and send you a bill.
I would point out that the attending surgeon, the anaesthesiologist, and the hospital all bill the patient separately here for a surgery, in Ontario, Canada. (Most people will never see these bills and it's covered by the public insurance.)
The reason is that the service - the contract - is organized in that way. Between the patient and the anaesthesiologist, between the patient and the surgeon, and between the patient and the hospital. So three separate bills. The doctor and hospital will have their own contract. Legally, and in an important way when it comes to decide who to sue for malpractice, the hospital is not the provider or performer of the surgery. They just provide the venue and equipment; the doctors do the surgery.
But why is done that way? Lots of freelance chefs move between restaurants but the bill is always between the restaurant and the people who dine there.
Because historically doctors were in private practices. I still am, as an anesthesiologist. Many of the surgeons I work with are also private.
So, since neither of us is employed by the hospital, we do our own billing. If we were hospital employees, we could indeed do unified billing. That's a better analogy; your chefs are expecting to be paid by the restaurant, so it collects the bill. I am not paid by the hospital except a stipend for taking call for them - not for any specific services I provide to patients.
It's frustrating for patients and families, it's annoying for us, but it's the price of legal independence for us. If my hospital collapsed overnight (and they sometimes do), my group could go out and start working other sources of income right away, because we already have the business setup to do our own billing.
Your explanation doesn't seem like anything but a well polished justification for what is ultimately a dubious shakedown. Without actually consulting with a patient and agreeing upon pricing well ahead of a scheduled surgery, you have absolutely no business requesting any payment directly from them. These billing charades revolve around some utterly perverse idea that obtaining someone's identifying information somehow confers some right to unilaterally bill them arbitrary amounts. For sanity's sake, everyone else can only hope this broken and illogical system is on borrowed time and will get stamped out hard. And you can most certainly retain your legal independence and work for multiple vendors as a subcontractor, like in any other industry.
> Without actually consulting with a patient and agreeing upon pricing well ahead of a scheduled surgery, you have absolutely no business requesting any payment directly from them.
Well, if you want to turn this into a rant on how incredibly backward the way things are done is, I'll agree with you that it's a terrible method. But it is the way things work. Don't believe me? Ask your insurance company. Your deductible is not payable to the insurance company; they require the billing entity to collect it themselves (and thus spread the risk onto us - they don't pay our negotiated fee, they pay the negotiated fee minus your deductible and it's up to us to get it from you).
> And you can most certainly retain your legal independence and work for multiple vendors as a subcontractor, like in any other industry.
Again, look at how health insurance in the US, as a whole, works. And, for that matter, hospitals (for- vs not-for-profit is a mostly meaningless distinction in this).
Sure, it's the way things are done. What I'm questioning is why it should even be expected to "work", apart from people's seemingly misguided sense that what essentially amounts to a request for a tip is somehow a binding debt they're obligated to pay. What you've described is the exact same set up as a waiter at a restaurant. And yet despite waiters often handling identifying information, nobody gets a post-hoc bill in mail asking for arbitrary table service fees. And if some waiter did try this hustle, the recipient would likely roll their eyes and toss it in the bin.
> Your deductible is not payable to the insurance company; they require the billing entity to collect it themselves
Sure. I wouldn't call this backwards - rather inconvenient but still legally sound. The provider enters into a contract with the "insurance" company that requires this. The customer enters into a contract with the provider by requesting and using their service, so the provider can bill the customer.
What you (and most of the industry) are somehow claiming is that even though the patient already has a business arrangement with the hospital for treatment, that the hospital calling in a subcontractor means that subcontractor is somehow entitled to bill the patient directly despite having no business relationship.
And historically, grocery suppliers are not owned by the grocery store I go to, but it would be completely batshit insane for me to go to Kroger, buy a bag of potatoes, and then three weeks later get a separate bill from some potato farmer for it.
It's still better than billing to the hospital and the hospital billing to the patient, piling up taxes and comissions. The patient is also getting more cost transparency instead of a bundled bill one can never make sense of.
I don't agree with the last point and I think this thread is evidence of that. We cannot make sense of the myriad of bills we get from all the different providers, particularly since many or all of them are also being dealt with by our insurance and may have already been negotiated by the time we get the bills in the mail.
To that point, I went to the ER a few months ago and I've probably received ten or so mailings for unpaid bills, only one of which I actually ended up owing, but my insurance didn't make the claims visible until they were settled which was months after the fact. To make matters worse, I can still log in and pay bills which were settled by my insurance. And I've received bills in the mail -- late I assume -- after they were paid by me or settled by insurance, confounding matters further.
Transparency would be far more useful if it came before the service being rendered.
Obviously there are some practical limits in exceptional cases, but I can't think of another industry that has high-price services where providing estimates isn't standard.
The problem is that in many cases, there is no way for a patient to meaningfully review options, negotiate, or even consent prior to receiving treatment. For non-elective procedures, at best it's an "under duress" sort of deal.
This is why healthcare should be provided for free at the point of service, paid for by the government. It works very, very well for many other countries. The only reason we haven't been able to make it work here is the rampant lobbying.
And since the topic is debt, how do you think that affects the small private practice? The hospital, that has scheduled and contracted the doctor, on site, with the hospitals equipment is more able to have a loss column than an individual.
This seems like something the IRS should fix; as all of the above makes the contractor an employee of the hospital.
Can you imagine flying on a Delta flight and you have to pay a separate bill to a 3rd party maintenance company.
Server is better analogy. The wage you pay/owe the waiter is direct and (mostly) separate from meal, albeit informal with only shame as a deterrent for default.
Not seeing these bills would be incredible. Having them all covered in the same way would be fantastic. Instead, for us, states need to enact surprise billing laws since each provider can mysteriously be out-of-network despite working within a hospital that is in-network. The in-network concept is complete bullshit to start with, but then you have to have complete documentation of every person involved in whatever care you are getting.
This is what infuriates me the most about healthcare in the US. I give someone my card, they enter the numbers with no indication of whether or not everything will be covered by insurance (they assume you just know).
Then, a month later, I receive a bill indicating a routine procedure that I assumed out of ignorance was covered by insurance (since they took my card and entered the numbers without saying anything to the contrary) for $500 (or, god forbid, more).
If I knew a salad at a restaurant were $200, I probably wouldn’t order it. There is no basic transparency in medical billing, and that needs to change.
It’s actually even worse. If you (or the Dr’s) could reliably tell how it was even going to be coded (aka categorized/identified) in the system in advance, it would already be a huge step up.
Then you’d only have a handful of different prices you might have to pay.
It all feels quite postmodern to me; like it's all made up as you go along. Try to ask how much something is going to cost in a medical context and they'll usually look at you like you're stupid (and I mean like a shoulder x-ray, not something that involves a team of people and maybe some unknowns when they cut you open). Well fine, but if you can't tell me how much something is going to cost, then I can't tell you if I'm able to pay it, so I guess we'll find out together.
I like Kaiser in that sense. None of this separate bills monkey business. In fact, for my plan, no bills at all. Just upfront co-pays and then you're done paying.
I really like Kaiser as well, but afaik, they are one of the most expensive providers out there. I've only had Kaiser once, many years ago and the company dropped them because the cost to insure each person was significantly more expensive per person than everyone else. This was in a place where the average age was less than 35. I can only imagine what it costs now, especially for companies with a higher age average.
> I really like Kaiser as well, but afaik, they are one of the most expensive providers out there.
Yeah, but what would you pay in taxes in a country with universal healthcare? In Maryland, I pay a similar total tax rate on a top 1% income as our German au pair did at her entry level desk job. Germany’s tax to gdp ratio is 39%. Ours is just 28%.
It's very expensive being sick for any extended period of time; I had my first partial glossectomy surgery (removal of a piece of my tongue) in October 2022 (https://jakeseliger.com/2023/07/22/i-am-dying-of-squamous-ce...), and there are at least three major components to being sick for a long time: health itself; financial viability; and managing the healthcare team.
I've been lucky with the generosity of friends and strangers regarding the second one due a successful Go Fund Me, but I've also gotten walloped with some gnarly bills, most notably for Signatera blood tests for cancer particles and for genetic testing of the tumor itself. United Healthcare considers those experimental and thus uncovered. But the genetic testing of the tumor is essential because it might lead to targeted treatments.
Legislation has supposedly limited surprise out-of-network bills, but, even with insurance, costs can be very high, and those combined with not being able to work effectively leads to problems.
Alternatively, they could consider not having lone employees mass-denying procedures from a spreadsheet. Or at least stop using the AI that gets it wrong so often it's indistinguishable from intentional.
I think biggest problem is health insurance is now more like a weird HSA where insurer owns the money and operates as cartel. It might be cheaper for some to not even have it and just go to Mexico, maybe some minimal insurance only for emergency room.
Hard to call it insurance, when so much used for known chronic ongoing costs.
Profit margins are like 4% on health insurance. Insurance companies introduce a lot of cost and waste, but there's no evidence to me these mass denials are anything but the market not bearing real insurance that covers things reasonably under current regulatory conditions.
Could it be the consumer is too poor to pay for a bloated system that covers what it does, plus the mass denials?
The whole system is fucked and the even more fucked part is mass denials may be a symptom of the madness of the inefficient rube Goldberg machine and not even a profit driver.
The jig here is that even though profit is a reasonably slim 4%, the water bottle is being sold at an outrageously high price.
IOW, medical insurance is both expensive and not very profitable because hospitals are charging tremendous sums (and implied that they are overcharging).
That doesn't explain the denials though. My point was that they're apparently doing mass denials and still barely breaking a profit. It suggests the consumer wouldn't be able to afford the insurance that doesn't, if it's not a small piece of the puzzle, otherwise they'd pay more for that.
I have been fighting these battles for much of the last ten years and this article fails to explain a dynamic that is happening here, at least where I am (california).
I'll give my most recent thing that ended up in collections (which you can easily ignore, it doesn't affect your credit at all in some states). I had a pretty intensive surgery. I had a copay, which was shown to me before the surgery. I signed it, paid, think everything is good.
However, in the background, which happens often, the insurance company and the hospital/doctor are still haggling about who owes what. Eventually they can't come to a decision, and the hospital punts it to the patient or collections. Even better - say you do pay this “surprise” bill. Sometimes the insurer eventually pays up. Guess what happens then? Does the doctor/hospital notify you then that you overpaid?
Very rarely. For me it was a $800 bill on top of the thousands I already paid for anasthesia (and some other stuff).
Hospitals and insurers are putting patients in the middle of their disputes and it rarely ends up well for the patient. Hospitals acting like they're somehow the victim here is extremely rich from my perspective, they are at least half of the entire problem.
I recommend letting them go to collections and then disputing it there. Lots of times these collections agencies use shady practices that give you some good leverage, or it's a double billing scenario like I described above.
I recently had success using CA's Dept of Insurance to assist me in convincing a health insurance company to pay a health provider what it says on my policy. I filled out the form online[0] and in less than a month, the insurance company decided to pay the full amount I expected. I only wish I had used the DOI service sooner as I wasted months getting shuffled between insurance company departments in their never ending quest to make me go away.
This seems like a good thread to mention the book "Never Pay The First Bill" by journalist Marshall Allen. I've worked in healthcare for 20+ years. I've been on the collecting side of many bills, it's a good book for patients. Contrary to popular belief most hospital systems are not evil profit seeking corpratons but just trying to keep the lights on, it's still a business though and as a patient you have the right and oppourtunity to negotiate. Most of the time collecting something is better than collecting nothing which is more or less the default. Of course there are exceptions and abuses.
One other point I think is important, that I see come up a lot regarding deductibles, is that your deductible is most likely double what you think it is for a lot of situations. Particularly emergencies. This is buried in the minutiae of your insurance and relates to in and out and network/facility/doctor care having seperate deductibles.
Except you're tone deaf trivializing systemic evil as a banal "business misunderstanding".
I was roadtripping through Redding, CA several years back. While in line at a coffee, I ran across a young lady with a nasal infusion pump tube taped to her face arranging some paperwork. After chatting, she informed me she had Stage IV cancer and the hospitals and doctors were coming after her for every cent she had while she was dying, and it forced her into bankruptcy. The paperwork was for her bankruptcy hearing across the way.
This is what happens when for-profit health insurance and hospitals are allowed to exist because every other sensible advanced economy in the world has universal healthcare. The disconnect is American patients don't know how bad they have it: their financial liability is essentially unlimited, they pay far more, and have worse outcomes.
> This is what happens when for-profit health insurance and hospitals are allowed to exist because every other sensible advanced economy in the world has universal healthcare
Many of those universal systems have for-profit insurance and for-profit hospitals too.
A nasty truth is when people are terminally ill, the vultures emerge. With animals too. In socialist paradise your kids dispossessed because inheritance is immoral. In capitalist paradise, dispossessed because the hospital can charge the captive buyer limitlessly. Doesn't matter what system, the order of life plays out.
Humans are chimps with high order skills to do the same chimp shit and explain it away with various fictions.
No, the American system is measurably worse. Dying destitute of a preventable cause is a uniquely American phenomenon contrasted to Western nations with socialized healthcare within capitalist frameworks.
To be fair, when you see these giant corporations buy up every private medical practice from one side of the state to the other it’s hard not to see them as evil and profit seeking.
When you walk into the lobby of the hospital and it’s guilded with marble floors, vaulted ceilings, and chandeliers with large spacious “offices” for the billing departments, it’s hard not to see them as evil and profit seeking.
When you can’t get a straight answer out of anyone at the facility regarding cost of a simple procedure, it’s hard not to see them as evil and profit seeking.
When you see the executives of these hospitals wining and dining with the insurance executives then suddenly next year your premiums and deductibles get raised, it’s hard not to see them as evil and profit seeking.
Do I think that all medical professionals are evil and profit seeking? No. Do I think that many of them are content to live under an umbrella of plausible deniability as long as their paychecks increase? Absolutely.
I want to be clear that I agree there are significant problems. I understand this commonly held perception but more than 29 states make it outright illegal for a regular for-profit corporation to own anything which engages in the practice of medicine. Look up "corporate practice of medicine" laws. That isn't to say there aren't problems. As a former hospital executive I can tell you first hand there is no love lost between hospital systems and insurers. A lot of hospital systems operate with a level of incompetence and dysfunction that it is truly difficult for regular people to appreciate. In many many cases a medical provider may not have a clear picture or be able to get a clear picture of what they will actually be compensated by your insurance for a given procedure. I understand that sounds crazy but it's a real thing. Competent organizations handle that situation a lot better than incompetent ones.
If you go back and read the various dicussions, arguments and controversies from around 1984 regarding the enactment of HMOs it is my opinion that things aren't dramatically worse than at that point.
Executive compensation is an issue in a lot more industries than healthcare. I think that there are big problems there. The structure of hospitals as a medico-legal entity is a complicated business in most states. When you say "CEO of a hospital" it typically does not bear much relation to what you say when you say "CEO of Disney". In healthcare there is among other complicated things "corporate practice of medicine" laws which prohibit non-medical ownership of medical organizations. So a "Hospital CEO" may often be the head or a chairman of a foundation or entity that owns the real estate that a hospital uses or sometimes is just the practicing head of medice of a medical organization or any of a myriad of other byzantine structures. That doesn't make excess compensation any better but it's important to identify what someones role actually is and what they are compensated for. Most hospital systems are a little more like medical malls than any singular beast.
A lot of this has changed with the No Surprises Act, that specifically covers Emergency situations and others where a patient would be "reasonably expected" to believe that a service was in network.
Surprise billing protections apply to most emergency services, including those provided in hospital emergency rooms, freestanding emergency departments, and urgent care centers that are licensed to provide emergency care. The federal law also applies to air ambulance transportation (emergency and non-emergency), but not ground ambulance.
It also covers non-emergency services provided by out-of-network providers at in-network hospitals and other facilities. Often, the doctors who work in hospitals don’t work for the hospital; instead they bill independently and do not necessarily participate in the same health plan networks.
Doesn't mean your insurer might not deny coverage or apply a deductible that you have to fight.
You also cannot waive certain rights. Like some hospitals will try to get you to sign waivers around balance billing, and in/out network discrepancies. Some of these will vary by state, so be aware.
> The No Surprises Act (NSA) establishes new federal protections against surprise medical bills that take effect in 2022. Surprise medical bills arise when insured consumers inadvertently receive care from out-of-network hospitals, doctors, or other providers they did not choose. Peterson-KFF and other studies find this happens in about 1 in 5 emergency room visits. In addition between 9% and 16% of in-network hospitalizations for non-emergency care include surprise bills from out-of-network providers (such as anesthesiologists) whom the patient did not choose. Surprise medical bills pose financial burdens on consumers when health plans deny out-of-network claims or apply higher out-of-network cost sharing; consumers also face “balance billing” from out-of-network providers that have not contracted to accept discounted payment rates from the health plan.
To clarify my point, your insurer spells this out to you, though you as a patient may not understand it to be the case. There is no surprise, its the expected behavior reading the literal minutiae of the giant packet your health insurer offers you. It's just that many people do not understand they have multiple additive deductibles for certain types of care.
I have good insurance and I have unpaid medical bills for the following reason:
1. Visited a doctor 4 months ago, got a bill 3 months after the visit, paid it, then got a surprise second bill, which I have put off paying because I need to find time during my work hours to follow up on with the hospital + insurance.
2. Didn’t get bills for some of the visits I made in the last 3 months.
3. Insurance randomly denied claims, so need to follow up with them and the hospital.
4. Despite insurance covering 70-90% on different services, one visit for my spouse cost us thousands. We decided to pay it off as installments instead of one time because we got a really good deal.
This was us for my wife's pregnancy and delivery. Some of the bills were denied by Cigna for things that were covered according to their book. So we had to fight that. Cigna can take months to reprocess claims, which basically puts you into default with the hospital while you wait for the insurance to pay out for services that were supposed to be covered. We've done this after every medical event because Cigna always denies something that should be covered. And their accounting system doesn't work correctly which is something that is constantly your problem because they won't accumulate your out of pocket max or coinsurance correctly, so you CONSTANTLY have to call them about everything because it's always wrong.
Cigna is the worst insurance company I've ever had the displeasure of dealing with. United Healthcare was slightly better but only slightly.
For a surprise bill, my wife got fired as a patient by the biggest clinic network in our area for a bill that she didn't know she had and that the agent she talked to wouldn't provide any evidence or itemization. The agent's response when asked was "you know what this is for you should just pay it." Sounds scammy, right? They keep buying clinics we're going to and then she stops being able to see her doctors afterward.
Private equity is destroying our healthcare system.
Buried midway down, they mention that the commercial health plans available to people without conventional employers (Obamacare) can (and routinely do) set deductibles as high as $9,450. And that’s in addition to the premium-which, in New York City for example, starts at $618/month for the very worst plan for an individual. Sure, that’s subsidized for lower-income households — but who among those has a spare $10K lying around to spend out of pocket before they actually benefit from the insurance?
When you’ve budgeted the $7,400 to pay for premiums whether or not you use healthcare, and the insurance doesn’t even kick in until you’ve spent a total of $16,800 on medical care in a given year, it doesn’t come as a huge surprise to me that people feel like they’ve already paid enough, and that the payers and providers should sort it out amongst themselves.
There’s economic, contractual, and policy reality; but then, even among people who might be able to afford it, there’s the gut feeling of “I’ve already paid way too much for this 5-minute checkup, I’m not paying more.”
We should've gotten single payer. The insurance lobby is just too strong, I guess.
In several recent years, I would've been better off not having insurance and paying out of pocket because I never (or just barely) hit the deductible. Even when my deductible was lower, if you added up my premiums against what was covered I still probably overpaid most years. So all I've been doing is subsidizing someone else's bills while paying my own on top of it.
Yes, I know this is how insurance works, but it doesn't feel great to keep paying out so much money while getting nothing for it but vague promises they likely won't have to keep which expire every year.
Single payer was killed by the healthcare provider lobbies, not the insurance lobby.
Doctors have waged a war against single payer anytime it has been suggested for over a century. The power the doctor and the hospital lobbies wield to sway opinion utterly dwarfs that of the health insurance industry.
There are multiple reasons I can imagine why that might be, but I would love to see some citations for this so I have solid data I can confidently adjust my world view with.
My opinion is that insurance companies are middlemen who too frequently rob patients & providers alike, and I would expect any reasonable legislation to include provisions to ensure that being a doctor is still financially attractive.
Coming around full circle, the cost of malpractice insurance is now so high that it's become a significant barrier to entry for anyone trying to start a new medical office, and I think that should be addressed as well.
That people believe healthcare providers, where the vast majority of the $4.5 trillion in healthcare spending ultimately goes, are just barely getting by and that they're being robbed by insurance companies (~5% of spending) should be ample evidence of how powerful they are.
Never mind that private insurance reimbursement rates are higher than Medicare's and even Medicare's rates are double that of every other advanced developed country.
In my case, not hitting the deductible is the wrong metric.
You are still benefitting from the insurer's negotiation of lower rates for all procedures. For example, your insurer may have negotiated $0 for standard bloodwork.
The parent's acknowledgement that "this is how insurance works" doesn't change the fact: that IS how insurance works. Coverage of a risk has a value, even if that risk does not materialize. (This is easier to understand from the point of view of the finance markets, but it's the same everywhere.)
Insurance companies are very much to blame, sure, but that doesn't change the fact that >50% of the country rejects these systems because "socialism". If we can't get over that hurdle first then nothing will ever change.
Socialism is such a stupid argument because we pool our taxes for common things such as Transportation infrastructure, defense, port immigration, and other social benefits.
Australia charges 2% for medicare (I'm sure other countries have something similar). Because the money is pooled, they can negotiate prices for common procedures and medicine down.
I'd rather pay 2% extra tax for not having to deal with getting new insurance when I switch jobs. An x-ray shouldn't cost in $1000s.
Australia still has private insurance and special surgeons. The deal is that the 2% covers most common basic heathcare related things.
Imagine if we had to pay separate tax for going on each highway. Middlemen sitting and ripping off based on demand and supply. Getting billed for each highway use and having those bills come months later. Because it is so expensive to travel, we'd need highway and flight insurance.
That's the absurdity of US healthcare. Play stupid games, win stupid prizes.
Obamacare was essentially gutted when the individual mandate was deemed unconstitutional and removed. If young, healthy people aren't signing up and paying into the system then of course the sick ones will bear the brunt of it. That's just how insurance works.
I’m unemployed in NYC right now - so, zero consistent income. I’m one of those people with the very worst marketplace health plans. Here’s what I get for $640/mo (with a $120 tax credit, oh boy!):
- Visits to my general practitioner (but not so fast! no diagnostic tests or ANYTHING else - those are 100% out of pocket until my $9,000 deductible is met)
- Pregnancy care (it’s currently a biological impossibility for me to give birth)
Everything else is entirely out of pocket until my $9,000 deductible is met. My coverage is basically a $6,000 guarantee that I won’t be completely bankrupted if I get run over by a garbage truck and live to tell the tale. Otherwise, it’s completely useless. Something’s gotta give.
Interesting. I am using an obamacare plan (in Kansas). It's in no way an amazing plan, but I only pay single digit (or was it $10, idr) premiums per month, and my deductible is $1200. I've been pretty pleased with obamacare for the three years I've had a plan with it.
The definition is amusing. "Have the ability to pay but don’t."
They don't exactly make it easy. I'm usually good about this but am probably on this list right now. My cat got out of the house and bit me on the hand last year around this time and it got infected and swelled up. Went to one of those boutique ERs with no wait, which I specifically did because I have plenty of money and can pay. They still couldn't bill me everything on the spot.
Four months later, when I got the rest of the bill, which is only $117, I tried to pay online and their website said my account number was invalid. It's the number on the bill they sent me. So I tried to call to pay and the payment center apparently is staffed by one person and if you call when they're at lunch, you're out of luck. It can be paid by mail, but they don't provide postage and I last sent mail on purpose on any regular basis over a decade ago and don't have any stamps.
So oh well, suck it. I'm not going through that much more effort to pay you $117. If you're seriously willing to sell that for $2 to a debt collector, have fun. Even if I ultimately pay, the labor and paperwork on behalf of all involved parties is probably enough that every single participant loses money.
> My cat got out of the house and bit me on the hand last year around this time and it got infected and swelled up.
Always have betadine on hand. My cat scratched and bit be numerous times, never had an issue, always washed with plenty of soap and water and disinfected the wounds with betadine.
Indoor cats also go crazy. I'm never keeping another cat indoors without free roaming access.
I generally oppose declawing cats but it may help in this situation. Free roaming and outdoor cats decimate local bird populations, that's the primary reason I kept my cat totally indoors.
We a have free roaming cat at the office. It doesn't bother with birds or mice, as it has learned to bug humans to feed it and it's quite succesful at it. So there's no need for declawing = amputating its fingers. Very active cats like the common European are not fit as indoor pets and might develop a stress disorder if kept inside at all times.
At any given time I have a few hundred dollars of unpaid medical bills because they are so inconsistent. Some don't show up for months. Some show up right away. Some are tracked in the providers' proprietary apps. Some are sent by mail.
Some, I don't learn about until they're in collections. Did I miss an email/notification/mail? No idea and no way to tell.
There should be a provision in law that mandates the presentation of a final bill within x number of days of services rendered.
Right now they want to have their cake and eat it, too. “We can’t tell you how much it will cost ahead of time because it would be too difficult”. But also “ we can randomly bill you at some point from now until the end of time until we decide that your debt is paid.”
This is the kind of headline you have to be careful with because as long as there's debt there will be a majority of debtors. Without raw numbers, this could mean more insured people are getting into debt _or_ it could mean that the US has gotten better at providing cost-effective health care for the uninsured. If that's the case, than this headline is something to be celebrated.
Let's say last year 100 people were in debt to hospitals - 40 insured, 60 uninsured.
This year 70 people are in debt to hospitals - 40 insured, 30 uninsured.
Great!
(I know that it would be much better if no one was in debt, but that's a separate discussion.)
(Also possibly fewer uninsured people are in debt because they all died of treatable conditions but that conclusion will have to wait on more data.)
Don't let yourself get caught up in these details. The problem is the unreformed healthcare system; these are just more symptoms of it. It's like the old, failing server at work - people say the problem is the power supply, the outdated driver, etc. - it's not; the problem is we haven't installed a new server.
We all can see the US healthcare system is awful. If you aren't doing anything about it, the problem is you. The politicians against healthcare reform are well-known; if you can't persuade people to vote them out, you're not trying (following the example of political leaders who don't try). (And spare me the helplessness routine - that's for losers - generations of Americans and other democracies have managed to get things done.)
EDIT: People need to stop debating whether they are powerless, and the 999 ways they are powerless, the hopelessness of powerlessness - and start posting solutions.
Another thought: It's another institution or market being funded by the wealthy (donations) for the wealthy (those who can afford it).
> If you aren't doing anything about it, the problem is you.
What do you expect me to do about it? I live in a reliably blue area and it's Republicans who are blocking things like a single-payer system.
So what exactly are you suggesting? Uproot my life and go move to a swing state so I can vote Democrat there?
Because short of that, I don't know what. And the country is so culturally divided, it's not like there are many swing voters left who can even be convinced anymore. Republicans just don't want health care reform, so what are we supposed to do?
You're right. You're helpless. Is that what you want to hear? Is that what you say at work? Is that what you tell your kids when they have a problem? Take step back - this response is beneath us; it's making ourselves victims.
I could spell it out concretely, but the problem is the approach, the attitude, that talking like helpless victims is somehow ok. It's completely irresponsible - an abdication of our responsibilities to ourselves, our communities, our country, and future and past generations. Change that, and you won't need me to tell you what to do, you'll be busting at the seams with ideas and drive.
Imagine where we'd be if past generations adopted this helplessness. Imagine Washington, Jefferson, and the rest, facing the British empire. Imagine FDR, Churchill, MLK, and so many more. That's who we need to live up to. I've never heard them talk like Americans today.
There are lots of people with drive on the Democrat side -- look at everything Bernie inspired, for example. There's ideas and drive aplenty. Look at the optimism that propelled Obama into office. And then look at how little he was able to accomplish, compared with what he hoped to. Look at how he discovered that Republicans wouldn't work with him, no matter how bipartisan he tried to be.
Because Republicans have drive too, in service of their own ideas -- ideas which are diametrically opposed to all of that. And they have the votes to block anything meaningful.
So again, please spell it out concretely. How do you propose to overcome the power that Republicans currently wield? I'd love to hear your thoughts spelled out -- your effective political strategy here to get the votes.
The only advice is: Get up and start working, start thinking and focusing on solving problems, start organizing and winning.
Any leader, any manager, anyone with life experience can tell you: If I do it for you, then nothing has changed.
Yes, Republican Party political tactics - pretty consistent since at least 2000 - have been effective. Why would they stop until someone stops them? Did you think those power-brokers, the vested interests, would make it easy? That is the nature of politics. It's not an exception; that's life; the enemy will fight.
FWIW, Obama avoided confrontation; he never confronted them and stopped them. Same with Hillary Clinton, same with Biden, same with most of the Dem congressional leaders. Why would anyone, except the most brain-dead or blind, follow leaders who won't even stand up for themselves, who exhibit cowardice when confronted with even the most vile, absurd foes?
And against them, you have the truth, good faith, good health and finances and everything else on your side. It couldn't be easier, in may respects.
I've said way more than enough. It's really an absurd situation. Stop talking to me and get to work.
Just a bunch of empty exhortation and generic advice.
Sorry but that's not helpful. A little bit of advice back to you: the world is a much more complicated place than you seem you to think. The real world isn't a morality play where simply having "the truth" and "good faith" makes it so it "couldn't be easier" to win. That's the movies. That's fantasy. Not real life.
A single-payer system doesn’t seem like a magic fix to me at all. At best, a single payer could, at least in principle, wield enough market power to improve the overall system.
Just look at Medicare. Medicare has enormous market power, but it uses that power in more or less absurd ways and does not optimize patient outcomes or its own expenditures particularly effectively.
The thing that is unique to the US is the level of corruption. Politicians are 100% beholden to corporate interests and nothing else. America’s dominance is entirely reliant on industry, so nothing can be done to upset the big corps.
Is corruption actually worse in the US than in countries with single-payer? I doubt it. Let's stop making excuses for ourselves and get it done.
Maggie Thatcher, who I don't pretend to love, once said (IIRC what I read, paraphrasing), 'Ask military leaders if something can be done, and they'll give you a hundred reasons that it can't. Tell them it will be done and ask how, and you'll get a hundred solutions.'
Adjourn the 'can-we-will-we-it's-so-hard' meeting, and convene the 'how' meeting.
Yes, in particular America has by far the largest pharmaceutical and medical devices industries in the world, so politicians in other countries have no particularly strong incentive to prioritize healthcare profits over wellbeing. Ask a thousand healthcare economists why healthcare in the US is so expensive and 99% will have this in their top 3 answers.
> Tell them it will be done and ask how, you’ll get 100 solutions
Here’s the solutions: demographic shifts due to death, labor strikes, or violence. Voting in 2024 isn’t one of them. I will still vote because it’s easy and makes some minuscule difference, but there is no mainstream political will for change here.
I just wanted to say thanks for that perspective -- I've often wondered what made the US so "different" from other developed countries in not having single-payer, and had always assumed the root cause was a cultural frontier-settler-independence attitude.
I never thought about the fact that we have a domestic pharmaceutical and medical devices industry, that's present in a way that's unique to the US. That's a factor you don't get in Spain or Norway or Australia. Very enlightening -- TIL!
> What do you expect me to do about it? I live in a reliably blue area and it's Republicans who are blocking things like a single-payer system.
So why did single payer healthcare fail in Vermont and California? European countries the size of Maryland manage to run their own universal healthcare systems. Why can’t states where democrats outnumber republicans 2:1 do the same?
Because you'll get the same issue as with the homeless, people from other states will come over to mooch on the better services. This has to be handled at a national level in order for it to succeed.
Legally, I’m not sure that’s true. I think discriminating against out of staters for health insurance could well meet the compelling interest standard of Shapiro v. Johnson, similarly to how states are allowed to discriminate against out of state students for public universities. And if it were challenged, I suspect the current Supreme Court wouldn’t be so inclined to further extend the broad “right of travel” found in Shapiro.
Putting that aside, the theoretical prospect that states would have to accommodate out of state moochers doesn’t seem to be the actual reason that the California and Vermont universal healthcare efforts failed. It seems like those programs failed because voters don’t want to pay for it.
If they're homeless, they aren't 'paying' into a single payer system, regardless of it being at the State or Federal level. People that pay little to no taxes 'mooching' off the taxpayer funded services is exactly the concern of many that oppose universal healthcare.
Considering many large companies self-insure their employees' healthcare, it seems unlikely that simply expanding the scope of who is covered is going to make the whole plan work.
Is "treatment" really the right word? Sounds like they're just exploiting them to sell invasive, irreversible surgeries that cause even more longer-term mental health damage.
Everytime I call it something else a dogpile appears accusing me of not being a medical doctor and how dare I commit the malpractice of deciding it is not treatment. Then come varying studies, which depending on persuasion are gamed in either direction by tweaking the constraints. Easier to not have the debate.
> The illusion of impact by writing to your congressman is really just that, a proverbial carrot in front of the donkey of democracy.
This is the hopelessness I'm talking about in the GP. It was edgy and clever to despair, but it's really for losers. Let's get serious; people are dying, democracy is dying; our predecessors managed to achieve great things and there's no excuse for us to sit on the sidelines and whine.
The question is what do we do about it? It sounds like you’re suggesting we can vote our issues away, but the voting and primary system is also corrupt.
The only way forward is to leverage our economic power (by forming unions or organizing a general strike). That’s the leverage we have against power, but ultimately a lot of what that looks like is lying down and doing nothing.
I don't disagree with your fundamental message, but as a non-American watching from the sidelines, what are you doing in a practical sense, other than whining on an internet forum?
The answer is the majority of the Republican party and their electorate, but just saying that will get you a barrage of downvotes on HN and other similar forums.
It was top billing in Democrat policy for decades, from Clinton through Clinton, and Biden did some too. Top billing in Republican policy was to oppose it and undermine it - remember the endless, pointless, virtue-signaling votes during Obama's administration by Congressional Republicans to kill Obama's healthcare plan. Remember he got it through on the slimist margin, through procedural maneuver, with (no? one?) Republican votes.
Organize and get the ball rolling. What are the problems? How do we solve them? You're not a customer or a victim; you tell them what they should be doing. Don't worry, most politicians will do anything to get some votes!
I remember how the ACA was essentially a giant gift to the insurance industry, and that despite being mandated in most states, only increased the insurance rate by a few percent. Oh, and the vast majority of the increase in insurance was health plans with a $10000+ deductible. I remember how medical debt bankruptcies continued to climb after it was passed.
> Don't worry, most politicians will do anything to get some votes!
Before they get votes, they have to win the money primary. Then we get to decide which technocrat or self-funded billionaire candidate sounds nicest to our ear.
It’s time to stop thinking you can vote your way out of this. Our leverage is our labor.
> EDIT: People need to stop debating whether they are powerless, and the 999 ways they are powerless, the hopelessness of powerlessness - and start posting solutions.
Well since you're the one claiming the problem is us, which is a pretty bold accusation -- what's your solution?
If you're making accusations that we're not doing enough, what are you doing then?
That's a common comeback - and again, it's doing nothing, spinning wheels, talking on the sidelines. The distractions are endless, but there's only one thing to do - get in the game.
It's fair, but it's a waste of time. It's fair to pick your nose, but not responsible to your community, the people who built it, and the people who will come after you.
Deflecting the question while simultaneously insisting others act without questioning ("it's a waste of time," apparently to ask questions) is an act of hypocrisy. Show us that you practice what you preach - and make no mistake, you are preaching.
One can blame politicians and corporations all they like, but the simple fact is that >50% of the country (and significantly more than that when accounting for skewed political representation) does not want the system to change, because to them any alternative is "socialism".
No it’s because socialism isn’t the only alternative and half the country wants to use it as an excuse to enact socialism, just like they want to use literally every other issue as an excuse to enact socialism.
To me the medical system is the worst of both worlds. It’s heavily regulated in favor of the businesses (insurance/hospitals) and gives the illusion of competition when in reality “networks” exist to ensure there is no actual competition. I think either full on socialism or fully free market would be a huge improvement.
> I think either full on socialism or fully free market would be a huge improvement.
Demand for healthcare is about as inelastic as it gets. And inelastic goods make for inefficient markets. One doesn't need to be a full-on communist to recognize that markets are not the correct solution to every problem.
Meanwhile, the fact that healthcare is tied to employment in the US has terrible consequences for small businesses and for the efficiency of the labor market. From where I stand, socializing healthcare is the pro-business move.
> >50% of the country (and significantly more than that when accounting for skewed political representation) does not want the system to change, because to them any alternative is "socialism".
As I said, if we can't overcome that absolutely weak, absurd argument, the problem is us (and many others). Let's get to work and stop talking like victims.
Distances to the VA can be far for many. It can be extremely difficult to be seen by another facility/provider. It can be difficult to get/use your benefits in general. PPOs are basically the same type of restrictions, only the facilities tend to be held to higher state standards.
A lot of veterans live in rural areas. Far more than you’d expect. Anecdotally, literally 100% of all the ones I know, but definitely not all.
If you compared normal insurance and care options where they are at (especially considering their income level) to VA care, it’s actually quite good. Especially if you know how to treat them more like an HMO and work the system.
Private rural medical care is… not great.
And usually requires a lot of travel. And unlike the VA, is rarely in a single facility.
Generally everyone bitches about it though, because that’s how the military works anyway. And yes there are often (changing) systematic issues, though they often get fixed.
Are there better options? Yes, especially if you’re high income and can afford a higher tier private plan, and/or live in a higher population density area where facilities and standards of care can afford to be higher. That is not a typical situation for most Veterans though, for many reasons. And not a typical situation for a lot of the population either.
Sure, once they pay their tax for decades, pay their premiums and copay, and buy their supplimental private insurance (not to mention facilities diffusing some costs through higher price setting of private parties). It's not a bad system, but you can't really scale a system that takes decades to fund and requires all these other costs. Especially since this conversation is about debt to medical facilities which can still occur under Medicare (or be forced onto Medicaid). Yes, supposedly it would save the US $2 trillion over 10 years, although there is some debate on that.
While not great, things are a little better in this area than they were a few years ago.
1) Even if it goes to collections, a medical debt won't appear on your credit report for a full year.
2) Medical debts less than $500 won't ever appear on your credit report.
3) If you pay the debt off later, the entire thing gets expunged from your credit report (i.e, rather than showing you had a debt that went to collections, and then was paid off, it's like the whole thing never happened).
These things only apply to medical debts, though, not normal consumer debts.
Every single debt should be contested. "Oh but I know I owe this". How do you know you owe it to that specific collector? Can you be sure it wasn't sold twice? Can you be sure the company didn't already write it off? Can you be sure that paying it means it'll actually be marked paid in their system?
The entire debt collection industry is a mess, and only the absolute worst players operate in it. If you try and stay honest and moral you will be taken for a ride.
My favorite was a reason I stopped going to a major famous hospital's outpatient clinic in my area, which was that their billing department would sell things to a debt collector that were paid, and when I called, they'd say you shouldn't be getting a notice our system says paid in full, and I'd say "well, then why do I have 12 debt collector notices with those IDs".
I suspect they were just opportunistically selling it faster than insurance paid them, but the harassment of cleaning that up every so often was exhausting (since the hospital would always say "well it's not on our end"), combined with a bunch of other shady things the place did.
The dumbest part was, they were like, $10 bills, so I can only imagine how cheaply they had to have been sold for the debt collector to think they could turn a not-loss on it...
It's probably impossible to know the full extent of this, but some percentage of hospital debt comes from people that can fully afford their healthcare but are using the payment plans as no-interest loans while their money is invested elsewhere. The HSA accounts you get with the high-deductible plans allow you to park the money in self-directed IRA accounts for your entire life. In fact, tax law encourages you to do this.
I don't think amounts that are on a payment plan would qualify as "bad debt" though - if someone is paying as agreed on a payment plan the debt isn't uncollectible.
> And as sudden operational cost pressures (including nursing shortages and higher wages) frustrate hospital financial leaders, an inability to collect all expected revenue further challenges razor-thin operating margins.
> This increase creates new challenges for providers to collect higher balances that are more difficult for patients to pay either prior to services or during the typical 120-day collection window after the insurance balance has been resolved.
I think they are being intentionally vague here. Are they saying they're having trouble collecting the money within the 120-day window (so their quarterly reports aren't screwed), or ever? I feel like they want you to believe that it is the latter, when in fact it is the former.
Hospitals love to do this thing where you set up a payment plan for auto-draft, but the moment you get a new bill, they cancel the payment plan with no notice and happily let your account go delinquent.
At that point, I just let it go to collections until the collector is willing to settle for a fraction. Or if I get lucky, the debt gets sold seventeen times and it just goes away once I ask for proof that they own my debt.
Play stupid games, win stupid prizes I say. If you wanna try and fuck around with me, I'll do my level best to make sure you lose as much money as possible.
I'm very far from a lawyer, but I've always been a bit confused how hospital bills are enforceable contracts given my rudimentary understanding of contract law. Turns out there are papers by smarter people with similar ideas:
> Thus, notwithstanding the type of contract created in a particular case, this article concludes that the proper application of contract law principles dictates that patients are usually required to pay no more than the reasonable market-based value of the health care they receive. The determination of reasonable value is based on the market value—the average actual reimbursement the hospital receives for the care in question—and not on the hospitals unilaterally-set list price or billed charge.
Has this been tested in court? I guess the main issue is that the people who receive the big bills are most likely to have the hardest time finding representation since poorer people are more likely to not have insurance. Really it should be illegal for hospitals to send any bill with crazy inflated prices that are negotiated down by all insurance policies.
The headline doesn’t say much and the text doesn’t say much more. It could be that such debtors are the majority solely because the number of uninsured has dropped.
For instance, if in 2000 there were 2000 debtors with 100 of them being insured, and in 2020 there are 200 debtors with 150 of them being insured, this headline would be true. Which would be ok if the story shed light on this, but it doesn’t.
I bill Blue Cross Blue Shield and the cost of a service was $125.
A different insurance was $70.
The medicaid patients are $40 (and our company would collapse if we only had these patients). They are basically break even, or a loss when they call off.
Now we aren't part of the hospital or physicians cartel, we are a tiny offshoot with no lobbying power... yet. Medical is a legal squeeze, not a technical one. Sorry for playing the game too. You need to fight against Medical.
At some point I hope Americans realize the extent to which they are being taken advantage of by the politicians they elect, and the companies that lobby them.
I think it’ll happen soon. If it doesn’t happen soon with the increasing numbers of unions and labor strikes, it’ll happen when boomers die off and the voting demographic shifts left dramatically.
because insurance doesn't pay full amounts, and often are left with a larger bill than if you didn't have insurance due to the "insurance premiums" that are charged because they know insurance won't approve the full amount
That's what I thought too, but someone who should know told me recently that's illegal (bill more to insurance than what the self-pay amount would be). Is that true or no?
I've been told my out of pocket would be a decent amount before, so I'll hang up and a week later call back and say I don't have insurance I'm going to pay cash and I get better rates. I don't know if it's illegal or not but it has worked for me.
This is the only debt I have, because hospital payment systems are fucking impossible to navigate. Thankfully, the Biden administration is drafting plans to make it unlawful to report that debt to credit reporting agencies, so I anticipate soon giving even less of a shit about it than I do now. Figure it out with my insurer, or bill me at the time of service. I'm sure as shit not responding to an invoice.
I'd love to adopt this strategy as well, but I worry about the clinic eventually forcing me to pay somehow and adding a bunch of penalties on top. Is there a way to mitigate that risk? Or is that risk unlikely in a way I'm not considering?
I'm not a lawyer, or a financial advisor. So: they could in theory sue you. But they're doing this to everybody, so unless you think they're going to sue everybody, I think it's a pretty safe bet? This has been my stance for over 10 years. I'll gladly pay if you ask me up front (or on the way out). Otherwise, fuck off.
I get how this attitude could sound shocking. I have friends who take a similar approach to other things and get away with it; most notably, a friend who refuses on principle to pay parking tickets. I pay parking tickets, and I still get whomped every 5 years or so with some absurd backlog of missed tickets and a boot, so I don't understand how this works for them. But it does!
You probably don't want to get me started on credit scores.
First off: I suggest you pay any reasonable bills you know you incurred and can pay. Don't be a deadbeat. That said...
As I understand it, it's pretty typical for these bills to be sold, and once that happens, the originator doesn't really care anymore. They got what they got and it's written off. Maybe they won't see you anymore, because you don't pay your bills; maybe they don't really care because lots of people don't pay their bills; if they were smart, they'd bill you at time of service, but chances are they're not organizationally capable of billing at time of service. If they won't see you anymore and you have limited options for medical care or they're the best option for medical care; you'll need to settle up. If not, the clinic has no means or desire to force you to pay.
The debt collectors have a time limited option to take you to court for repayment, but most of the bills aren't worth the effort, so you can probably wait it out. It might ding your credit, but if it comes up, you say 'hey, this bill correct' and it's a medical bill and everyone believes you.
If the debt collectors do file a suit, and you have the money to pay, negotiate a payout then.
Generally this is true. For anything over a thousand, I try to negotiate. Most of the time they rather compromise than fight/sell it at a % to collections.
I have simply had to say, I can't pay this* (*despite the fact it's simply violating my budget). What's the process for after a bill's due date expires? Sometimes the response is: it gets a penalty added. I reply, I can't pay that either. Can we work something out? Usually, I get connected to someone who will either offer a discount or payment plan. Sometimes this isn't going to be any better (payments for the total amount over time), but it's often interest free...since the whole point is that you can't manage it. Sometimes they are firm and say it will go to collections. At the heart of it, it's a matter of game theory. You don't get 100% of the discounts you don't pursue.
For my health provider, I currently have an otherwise unmentioned number I can call for my medical bills that I can pay immediately, that gets me 25% off whatever the bill is. I would never have known about it, had I not said I couldn't pay a particularly large one.
Call and tell them you cant pay. Will they accept (whatever 20% of the bill is). They will say no, but they will take X. Say, sorry I can't pay X how about (30%)....
Recently I'm getting it with the stupid "anesthesia is billed separate from the surgery" nonsense. At least this time I noticed the bill. Why is that not a single bill, though? Imagine having to pay the cook, cleaner, server, and attendants all separately. So frustrating.