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%.
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.