HHS announces rule to protect consumers from surprise medical bills(hhs.gov)
hhs.gov
HHS announces rule to protect consumers from surprise medical bills
https://www.hhs.gov/about/news/2021/07/01/hhs-announces-rule-to-protect-consumers-from-surprise-medical-bills.html
208 comments
> having insurance yet filled with invisible asterisks.
"Invisible asterisks" captures the reality perfectly. The asterisks are invisible and infinite. I think even Kafka would be horrified.
We've turned medical billing into an impenetrable Byzantine hellscape, and I fear that the only way to fix it would be to nuke it from orbit and start over.
"Invisible asterisks" captures the reality perfectly. The asterisks are invisible and infinite. I think even Kafka would be horrified.
We've turned medical billing into an impenetrable Byzantine hellscape, and I fear that the only way to fix it would be to nuke it from orbit and start over.
Medicare For All is the single most important policy in American politics right now, IMO, for this exact reason.
People complain that all the people in private insurance will be put out of their jobs - I view that as a feature, not a bug.
People complain that all the people in private insurance will be put out of their jobs - I view that as a feature, not a bug.
This needs to happen. The medical billing industry is literal cancer.
They sent me a bill for $350 then I called up to complain and suddenly the bill goes away because it’s billed to my other insurance that I didn’t even think I had anymore.
If I sent a client a random bill for $$$ things would not go nearly as nicely, but they have so captured the regulators and politicians that this is the world we live in now.
I want nothing to do with many of the policies of the left, but this would make things so much easier for small businesses and people Changing jobs in the labor market.
They sent me a bill for $350 then I called up to complain and suddenly the bill goes away because it’s billed to my other insurance that I didn’t even think I had anymore.
If I sent a client a random bill for $$$ things would not go nearly as nicely, but they have so captured the regulators and politicians that this is the world we live in now.
I want nothing to do with many of the policies of the left, but this would make things so much easier for small businesses and people Changing jobs in the labor market.
It's important to know some assets avoid probate and go directly to the beneficiary. These include things like a life insurance policy, or a 401(k) with a beneficiary information you can input, and possibly even update online (low friction). The health bill can go to the estate, but the estate also isn't comprised of the retirement account.
This should be common knowledge (but, unfortunately, isn't.)
A primary breadwinner should carry at least 10x his family's annual living expenses in term life insurance coverage.
Once the size of his retirement accounts exceeds this, he can start thinking about reducing the insurance.
Both will pay directly to beneficiaries in the event of his death.
A primary breadwinner should carry at least 10x his family's annual living expenses in term life insurance coverage.
Once the size of his retirement accounts exceeds this, he can start thinking about reducing the insurance.
Both will pay directly to beneficiaries in the event of his death.
You can setup a simple trust with the right form/software, and a visit to your bank for notarization. I don't know if a revocable living trust would protect your heirs against healthcare shakedowns, and it would likely depend on the state. But if the current corrupt system continues much longer, I can see irrevocable trusts becoming popular to protect yourself even while alive.
Sorry for your loss. This is one of the things that tends to get overlooked when discussing how awful the US health care industry is. You always hear: "US health care is terrible unless you have insurance!" But, it's also terrible when you have insurance! There are all kinds of ways doctors, hospitals, and insurance companies conspire to drain your pockets or your loved ones' estate's pockets, and they're all likely documented somewhere in a 100 page policy. The system is irredeemably beyond repair.
It more and more feels like the difference between not having insurance, and having insurance when something bad actually happens is "do I get a massive bill that I can't afford now, or do I get a massive bill that I can't afford later?".
The only real benefit of having "insurance" in the US is having reasonable access to basic preventative care. Don't get me wrong, it is a massive advantage to have default access to basic preventative care (without it being a cost-benefit tradeoff each time), but that is in no way/shape/form "insurance" in the typical meaning of the term.
The only real benefit of having "insurance" in the US is having reasonable access to basic preventative care. Don't get me wrong, it is a massive advantage to have default access to basic preventative care (without it being a cost-benefit tradeoff each time), but that is in no way/shape/form "insurance" in the typical meaning of the term.
Most of the time the system works for people who have good coverage. The tragedy is that "having good coverage" is a hard-to-control combination of luck in employer and/or wealth.
It's terrible that these things happen at all, and we CERTAINLY need to improve the US healthcare system, but exaggerations like "the only benefit of insurance in the US is access to preventative care" doesn't help. If people were regularly getting fucked like that the system wouldn't have the entrenched support it does from the "but I want to keep my insurance" camp, and so speaking in generalities like that just makes you appear uninformed to the millions who regularly see doctors, get treatment, have surgery, etc, without these problems.
It also cheapens the inequality problem: the gap isn't just "has access to preventive care" vs "doesn't have that access." The gap is "has hundreds of thousands of dollars, or even millions, of bills turn into nothing" vs "bankrupt if they seek treatment for any serious problem."
It's terrible that these things happen at all, and we CERTAINLY need to improve the US healthcare system, but exaggerations like "the only benefit of insurance in the US is access to preventative care" doesn't help. If people were regularly getting fucked like that the system wouldn't have the entrenched support it does from the "but I want to keep my insurance" camp, and so speaking in generalities like that just makes you appear uninformed to the millions who regularly see doctors, get treatment, have surgery, etc, without these problems.
It also cheapens the inequality problem: the gap isn't just "has access to preventive care" vs "doesn't have that access." The gap is "has hundreds of thousands of dollars, or even millions, of bills turn into nothing" vs "bankrupt if they seek treatment for any serious problem."
> Most of the time the system works for people who have good coverage.
I'm sorry, but I just can't see how this is true. Do you only go to the doctor for a yearly checkup, or something?
I've had "good" coverage (paid for by big employers with cushy all inclusive packages), and I've also had the cheapest option on CA’s exchange, and the only difference was whether I had to pay the receptionist $25 or $150.
The "we won't cover this" and the "surprise, this costs 50x what you were told!" billing nightmare comes six months later. This has happened with every insurer I've ever had.
I'm sorry, but I just can't see how this is true. Do you only go to the doctor for a yearly checkup, or something?
I've had "good" coverage (paid for by big employers with cushy all inclusive packages), and I've also had the cheapest option on CA’s exchange, and the only difference was whether I had to pay the receptionist $25 or $150.
The "we won't cover this" and the "surprise, this costs 50x what you were told!" billing nightmare comes six months later. This has happened with every insurer I've ever had.
It really does vary by individual. My mom is going through cancer treatment right now. 35K/month in medication and she pays $250. I don't expect surprise bills later. She had surgery 8 years ago for the same cancer and that was also $250, for a week-long hospital stay.
In my experience it does help to have an HMO. My mom uses Kaiser. So there's none of this in- vs out-of-network. One billing system, one insurance, etc. She has nothing but positive things to say about them. My dad had a similar experience towards the end of his life. He loved 'em. And nobody was left destitute as the result of his medical care.
In my experience it does help to have an HMO. My mom uses Kaiser. So there's none of this in- vs out-of-network. One billing system, one insurance, etc. She has nothing but positive things to say about them. My dad had a similar experience towards the end of his life. He loved 'em. And nobody was left destitute as the result of his medical care.
One of the problems with the how the US medical system works is that "35K/month in medication" is only "35k/month" because of some expectation that insurance is going to pay whatever the negotiated rate it (and I seriously doubt that it's 35k/month).
Lets look at it this way: If that was the true price, what percentage of the US population do you think has the funds to actually pay $420k/year in for medication?
Lets look at it this way: If that was the true price, what percentage of the US population do you think has the funds to actually pay $420k/year in for medication?
In this case the insurance is paying $25K/month for the medication, so they definitely did negotiate it down somewhat.
> what percentage of the US population do you think has the funds to actually pay $420k/year in for medication?
Zero, plus or minus. That's why the manufacturers basically give it away to people who can't afford it. Because they can, and it helps them somewhat mitigate the bad PR.
> what percentage of the US population do you think has the funds to actually pay $420k/year in for medication?
Zero, plus or minus. That's why the manufacturers basically give it away to people who can't afford it. Because they can, and it helps them somewhat mitigate the bad PR.
That shouldn't be the exception, that should be the rule.
I've had "good" coverage for my 15 year career and it does not work most of the time, or even half of the time. I've paid bills out of pocket because I didn't have time to untangle payer/insurance situations. I was taken to the ER unconscious once after a freak accident and ended up paying thousands for the ambulance. I've had to do provider paperwork myself and submit it to insurers myself because they refused to help me help them get paid. The system is simply not functional for people who don't have huge amounts of free time, patience, and money.
That is why I like the Kaiser HMO system. Most of the rates are pre-negotiated since the hospital and insurance are under the same company. Its typically $20/40 copay for a doctor visit. Even for me with my kidney failure and health issues, the OOP is minimal.
> “If people were regularly getting fucked like that the system wouldn't have the entrenched support it does from the "but I want to keep my insurance" camp”
I don’t see how that follows.
The “I’ve got mine” camp doesn’t care that it happens to those other people, and also doesn’t understand that it could happen to them in their old age (or simply after bad luck) because they’ve only made short visits into the system.
I don’t see how that follows.
The “I’ve got mine” camp doesn’t care that it happens to those other people, and also doesn’t understand that it could happen to them in their old age (or simply after bad luck) because they’ve only made short visits into the system.
After serving 3 large employers and reading through all the fine print attached to each health insurance policy, I can wholeheartedly say most companies do not offer "good coverage." After experiencing the fallout from my father's heart attack, I scoured through every health document I received afterwards, including but not limited to health insurance policies.
Of my different health insurance policies, the longest duration in an ICU that was covered by any of those insurance policies was 60 days. My father was "lucky" in that he was on a subsidized Obamacare policy that "only" charged $350 per month (which was cheaper than my employer's policy) but was FAR superior to any of my employers' health insurance in every aspect.
Of my different health insurance policies, the longest duration in an ICU that was covered by any of those insurance policies was 60 days. My father was "lucky" in that he was on a subsidized Obamacare policy that "only" charged $350 per month (which was cheaper than my employer's policy) but was FAR superior to any of my employers' health insurance in every aspect.
> If people were regularly getting fucked like that
I'm not sure what point you're trying to make, but it sounds like you're making the claim that people in the US don't regularly end up with massive surprise medical bills? This entire conversation is about action the government is taking because it happens so often.
> "has hundreds of thousands of dollars, or even millions, of bills turn into nothing"
That's not really how that works. It's not like your insurance company is actually paying "millions of dollars", they're paying some level of reasonable negotiated rate. If they actually had to pay "millions of dollars", that's when they claim something is not covered and you get stuck with a bill anyways.
Edit: First quote was just wrong from a bad copy/paste
I'm not sure what point you're trying to make, but it sounds like you're making the claim that people in the US don't regularly end up with massive surprise medical bills? This entire conversation is about action the government is taking because it happens so often.
> "has hundreds of thousands of dollars, or even millions, of bills turn into nothing"
That's not really how that works. It's not like your insurance company is actually paying "millions of dollars", they're paying some level of reasonable negotiated rate. If they actually had to pay "millions of dollars", that's when they claim something is not covered and you get stuck with a bill anyways.
Edit: First quote was just wrong from a bad copy/paste
When you have insurance, a claim should become purely a discussion between your insurance company and the health providers. It seems the current system needlessly inserts the patient into the middle, for the purpose of torturing him/her with paperwork, threats, bills, threats of bills, and the need to learn the intricacies of in-network, deductibles and co-pays, lifetime maximums, covered vs. uncovered procedures, etc. Instead of the insurance and health companies privately fighting it out between each other, they stick you in the middle, fighting through you as the proxy/punchingbag.
Wouldn't it be better if you went to the hospital, gave them your insurance information, and that's the last you ever were involved with anything regarding payment? Isn't that one of the reasons we have insurance?
Wouldn't it be better if you went to the hospital, gave them your insurance information, and that's the last you ever were involved with anything regarding payment? Isn't that one of the reasons we have insurance?
> The only real benefit of having "insurance" in the US is having reasonable access to basic preventative care
What insurance do you have where the cost of the annual premium is less than what the out of pocket costs would be for annual checkups for the covered individuals?
I have the cheapest insurance I can get. Yes, it pays for basic preventative care (basically a checkup per person per year), and it also costs more than my mortgage.
What insurance do you have where the cost of the annual premium is less than what the out of pocket costs would be for annual checkups for the covered individuals?
I have the cheapest insurance I can get. Yes, it pays for basic preventative care (basically a checkup per person per year), and it also costs more than my mortgage.
My wife is a primary care doctor in the United States. Saying that disqualifies me in some people's minds from having an opinion about the quality and cost of health care in this country. But I am willing to give an opinion regardless.
There are plenty of medical practices and institutions that function well and deliver good value to the patient. But there are many that do not.
As someone who doesn't have friends inside the health care industry, it can be extremely difficult to figure out what to do in an emergency. Quite often your options are limited especially if you are caring for a loved one rather than yourself.
The best advice I can give is to find good doctors before you need them, and when conversations come up about someone else's medical care, be willing to ask, who is your doctor and how good are they? Or, which hospital did you go to, and do you feel you had a good experience?
Often there is little out-of-pocket difference between the cost of excellent medical care and lower quality care, if you have good insurance.
If you don't have good insurance and you are looking at a potentially significant medical procedure, ask to speak to someone about financial assistance. Good practices and good hospital systems are not looking to bankrupt their patients.
There are plenty of medical practices and institutions that function well and deliver good value to the patient. But there are many that do not.
As someone who doesn't have friends inside the health care industry, it can be extremely difficult to figure out what to do in an emergency. Quite often your options are limited especially if you are caring for a loved one rather than yourself.
The best advice I can give is to find good doctors before you need them, and when conversations come up about someone else's medical care, be willing to ask, who is your doctor and how good are they? Or, which hospital did you go to, and do you feel you had a good experience?
Often there is little out-of-pocket difference between the cost of excellent medical care and lower quality care, if you have good insurance.
If you don't have good insurance and you are looking at a potentially significant medical procedure, ask to speak to someone about financial assistance. Good practices and good hospital systems are not looking to bankrupt their patients.
am hàppy to see HHS moving forward, long overdue!
most US doctors are part of a bigger group in order to provide more comprehensive coverage (and due to systematic buyouts), which in turn have preferred insurance providers and additional out-of-network providers, and emergency services are generally for wherever an ambulance takes you. your physician may be great, but they are just a tiny cog in a broken machine
one of the only outs, afaict, is something like working & living near a big & strong HMO like kaiser. but that comes at the cost of pretty firm boundaries on what services they allow: capped care
(my SO is also a physician at one of the nation's best hospitals, and despite that, patients struggle w the broader system outside of her practical daily control)
most US doctors are part of a bigger group in order to provide more comprehensive coverage (and due to systematic buyouts), which in turn have preferred insurance providers and additional out-of-network providers, and emergency services are generally for wherever an ambulance takes you. your physician may be great, but they are just a tiny cog in a broken machine
one of the only outs, afaict, is something like working & living near a big & strong HMO like kaiser. but that comes at the cost of pretty firm boundaries on what services they allow: capped care
(my SO is also a physician at one of the nation's best hospitals, and despite that, patients struggle w the broader system outside of her practical daily control)
>There are all kinds of ways doctors, hospitals, and insurance companies conspire to drain your pockets
People also want cutting edge care from some of the smartest and most highly educated people in the world (which is in short supply) for cheap.
People also want cutting edge care from some of the smartest and most highly educated people in the world (which is in short supply) for cheap.
People also want cutting edge care from some of the smartest and most highly educated people in the world (which is in short supply) for cheap.
Actually, people just want someone to help them with their health issues and not treat them like shit.
Sure, I guess you could find people with the above attitude, but it's mostly a straw man you are using to deflect responsibility from the health industry.
Actually, people just want someone to help them with their health issues and not treat them like shit.
Sure, I guess you could find people with the above attitude, but it's mostly a straw man you are using to deflect responsibility from the health industry.
There are HMOs, like Kaiser, that solve most of these problems. Unless I'm traveling, I would never have to worry about such extraneous bills. However, for any particular serious condition a particular HMO might not have the top-rated team in the country. This unreasonable fear is used by non-HMO insurance networks to draw customers.
Perhaps what we need is something like the WTO's most-favored-nation rule for domestic insurers, but imposed statutorily. If you're treating an out-of-network patient extemporaneously, you can only charge that person's insurer at the lowest rate you'd charge an in-network provider.
This would remove the incentive for out-of-network providers to eagerly provide many services. That has its own downsides, of course, but it might help to resolve many of these billing nightmares.
But, heck, maybe something like that already exists. Obamacare (aka ACA) comprehensively thought through many of these dilemmas. But enforcement has been gutted by the GOP.
Perhaps what we need is something like the WTO's most-favored-nation rule for domestic insurers, but imposed statutorily. If you're treating an out-of-network patient extemporaneously, you can only charge that person's insurer at the lowest rate you'd charge an in-network provider.
This would remove the incentive for out-of-network providers to eagerly provide many services. That has its own downsides, of course, but it might help to resolve many of these billing nightmares.
But, heck, maybe something like that already exists. Obamacare (aka ACA) comprehensively thought through many of these dilemmas. But enforcement has been gutted by the GOP.
In 99% of cases, you don't need or want cutting edge care— you need basic, efficient, timely care. The rest of the world manages to deliver that as a basic human right.
Yes .. but. Canada is often pointed at by Americans as an example of a functioning healthcare system. I can tell you we have many problems, but they are different. It might mean long queues for basic diagnostics/assessments/procedures, facilities that look ugly, excessive waits in the ER, and still paying an arm and a leg for medication. I have heard of great experiences in Canada but also pretty terrible ones.
I'm a Canadian too. Maybe I've just been lucky, but when I or anyone in my family has needed urgent care, I've never felt like I had to wait excessive amounts of time for it.
As far as whether facilities could be "nicer", I mean... maybe? I actually kind of prefer healthcare to be like schools in this way— if I don't think it's nice enough for me, then I need to lobby the province to collect more taxes and make it nicer for everyone rather than just taking my dollars elsewhere.
And that doesn't even address the whole billing-surprise angle. I would happily wait forever if the alternative was not knowing if I was going to randomly be stuck with a $10M bill.
As far as whether facilities could be "nicer", I mean... maybe? I actually kind of prefer healthcare to be like schools in this way— if I don't think it's nice enough for me, then I need to lobby the province to collect more taxes and make it nicer for everyone rather than just taking my dollars elsewhere.
And that doesn't even address the whole billing-surprise angle. I would happily wait forever if the alternative was not knowing if I was going to randomly be stuck with a $10M bill.
> Canada is often pointed at by Americans as an example of a functioning healthcare system.
To be fair, Americans have a very low standard for “functioning healthcare system” due to the American healthcare system.
To be fair, Americans have a very low standard for “functioning healthcare system” due to the American healthcare system.
Wrong. YOU might want cutting edge care from the smartest and most highly educated people in the world (not sure where you get this from however, healthcare in most of the developed world is equally good). Most people want decent care that does not involve them worrying that the next healthcare bill will bankrupt them. I highly doubt ludicrous hospital bills are a necessity to getting "cutting edge care", if so something is definitely broken (and is).
When I lived in Manhattan and worked with some really wealthy clients, they'd fly to France, Israel and elsewhere for care when they could have easily gotten the best care the US has to offer right down the street.
Personally, I just want to know the cost of services before committing to pay. I have been unable to get that in many situations, even for non-emergency care.
I do too. A doctor should be able to give you the codes for whatever routine or preventative procedure you’re interested in paying for, and you should be able to look up the price on your insurance company’s website.
It's not that simple. Doctors themselves often don't even know which billing codes will be used; coding is done by other office staff. And insurers don't have a single set price list. The patient's out of pocket expense will depend on a medical necessity determination and whether they have reached their annual maximum.
That is why I specified for routine or preventative procedures, where everything is known beforehand.
I also do not buy that doctors do not know which code will be used. I don’t care if the doctor themself does not know, surely someone that works with them knows and can provide it.
It should be dead simple to go to a doctor’s website and find the codes for routine procedure that they will bill. If something in the visit happens outside of that, the doctor can feel free to say that is outside of the scope of the visit, just like a mechanic can tell me he will not fix the transmission if I am in for a brake job.
I also do not buy that doctors do not know which code will be used. I don’t care if the doctor themself does not know, surely someone that works with them knows and can provide it.
It should be dead simple to go to a doctor’s website and find the codes for routine procedure that they will bill. If something in the visit happens outside of that, the doctor can feel free to say that is outside of the scope of the visit, just like a mechanic can tell me he will not fix the transmission if I am in for a brake job.
There is a pretty large continuum of potential value between the 'cheap' care that people want, and the ruinous bills that get charged.
Ruinous bills are frequently used to cover the costs of routine procedures. It’s another situation where 10% of the healthcare consumes 90% of the resources. It’s the person who needs 6 months in the hospital, the 2 month premature baby in NICU, the hemophiliac that needs $1M medication that balloon all the costs.
And no one can really afford that, but instead of spreading the costs around to all taxpayers, we were spreading it around by inflating everything else. ACA helps with this, but today’s announcement about out of network care will help more too.
And no one can really afford that, but instead of spreading the costs around to all taxpayers, we were spreading it around by inflating everything else. ACA helps with this, but today’s announcement about out of network care will help more too.
There is a pretty large continuum of potential value between the 'cheap' care that people want, and the ruinous bills that get charged.
That can't be true, everyone knows that people are only greedy and stupid, and it's really the citizens' fault for the prices of the current healthcare setup. The industry itself is all made up of kind-hearted super heroes who would never think of manipulating prices to syphon more money from patients.
That can't be true, everyone knows that people are only greedy and stupid, and it's really the citizens' fault for the prices of the current healthcare setup. The industry itself is all made up of kind-hearted super heroes who would never think of manipulating prices to syphon more money from patients.
Are American doctors really smarter than Dutch or Swedish doctors?
The context is Americans getting healthcare, so Americans would be choosing from people in America.
I would also point to the unnecessarily arduous and lengthy process of becoming a doctor in the US as one of the US system’s problems.
If I’m going to be asked to sacrifice all of my 20s and maybe early 30s and worked on 24 hour shifts during the prime of my life, I am also going to be making sure I get paid a ton for it. Otherwise, I would choose a different career.
I know a lot of doctors that advise their kids to not pursue medicine even if they want to do it, simply because the cost benefit is not worth it anymore (if you have other options).
I would also point to the unnecessarily arduous and lengthy process of becoming a doctor in the US as one of the US system’s problems.
If I’m going to be asked to sacrifice all of my 20s and maybe early 30s and worked on 24 hour shifts during the prime of my life, I am also going to be making sure I get paid a ton for it. Otherwise, I would choose a different career.
I know a lot of doctors that advise their kids to not pursue medicine even if they want to do it, simply because the cost benefit is not worth it anymore (if you have other options).
They’re probably comparable, but one advantage, no doubt due to our high costs, is that US hospitals tend to have a ton of resources and the latest equipment. This does make a difference if you have a condition that benefits from cutting edge treatments.
I recently had a family member get surgery for a life threatening condition where a cutting edge treatment greatly reduces complications. The equipment only exists in a small number of hospitals on the planet and their normal hospital, which wasn’t even a particularly fancy US hospital, had one. It's probably not an issue for small and rich countries though. Probably more-so for medium income countries.
I recently had a family member get surgery for a life threatening condition where a cutting edge treatment greatly reduces complications. The equipment only exists in a small number of hospitals on the planet and their normal hospital, which wasn’t even a particularly fancy US hospital, had one. It's probably not an issue for small and rich countries though. Probably more-so for medium income countries.
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Do the children have to pay off the bills of the parent? That doesn’t seem reasonable to me. It sounds like the best thing to do before getting too old is to transfer all your assets out so that if you die you won’t have it robbed by hospitals, etc.
It depends on the state. Some states have filial responsibility laws which require adult children to support indigent parents.
https://en.wikipedia.org/wiki/Filial_responsibility_laws?wpr...
https://en.wikipedia.org/wiki/Filial_responsibility_laws?wpr...
This is jaw dropping. How is this legal at all?
It sounds like a good startup. Do background checks on homeless people, see if they have any living relatives, and if so you can house them in a nursing home and charge the relatives.
It sounds like a good startup. Do background checks on homeless people, see if they have any living relatives, and if so you can house them in a nursing home and charge the relatives.
They're legal because they're laws. I think you might be asking how they're constitutional? They're constitutional because there's nothing in the constitution that prevents such laws.
Are they fair? I mean ... sometimes? These laws (supposedly) solved a problem where parents would bequeath their estate to their children prior the parents' death and, then, the children would leave their parents destitute. It's not clear how much of a problem this really was (think "19th century); it was probably just a popular image that politicians used as a talking point?
My suspicion is you'd need to use jury nullification to make the law "go away".
Are they fair? I mean ... sometimes? These laws (supposedly) solved a problem where parents would bequeath their estate to their children prior the parents' death and, then, the children would leave their parents destitute. It's not clear how much of a problem this really was (think "19th century); it was probably just a popular image that politicians used as a talking point?
My suspicion is you'd need to use jury nullification to make the law "go away".
>In 2012, the media reported the case of John Pittas, whose mother had received care in a skilled nursing facility in Pennsylvania after an accident and then moved to Greece. The nursing home sued her son directly, before even trying to collect from Medicaid. A court in Pennsylvania ruled that the son must pay, according to the Pennsylvania filial responsibility law
That is literally inheriting debt. That should be illegal, yet almost half the country allows this.
That is literally inheriting debt. That should be illegal, yet almost half the country allows this.
It's mostly just Pennsylvania. There are something like 29 different states with some kind of filial support laws on the books, but Pennsylvania is the crazy one.
Woah. And what if you had a terrible relationship with these people? What if you worked your whole life to get the fuck away from them?
This reminds me of tobacco tax to pay for children’s healthcare initiative. As if the responsibility sits directly with cigarette smokers. It sits on all of us, not one person. Impoverished elderly people that need medical care should receive aid from the state indiscriminately where we all foot the bill.
This reminds me of tobacco tax to pay for children’s healthcare initiative. As if the responsibility sits directly with cigarette smokers. It sits on all of us, not one person. Impoverished elderly people that need medical care should receive aid from the state indiscriminately where we all foot the bill.
No, they do not. However, the companies in question still might try to get the children to pay up in the hopes the children are ignorant that they are not responsible for their parent’s debts.
It depends on the bill and the state laws. E.g. debt collectors will use misleading and predatory tactics to get the children to pay "a token sum" that then makes the children liable for an entire debt.
While this strategy helps spend down to qualify for assistance near the end, all states have a lookback period that can disqualify you for state aide, and most look back periods are 60 months.
https://www.medicaidplanningassistance.org/medicaid-look-bac...
https://www.medicaidplanningassistance.org/medicaid-look-bac...
No, children aren't responsible for bills. It can only come from your estate.
Transferring assets isn't crazy but you do need to be careful if you want to do it in a non-taxable manner (you can't just give your kid $500k cash without them counting it as income).
Transferring assets isn't crazy but you do need to be careful if you want to do it in a non-taxable manner (you can't just give your kid $500k cash without them counting it as income).
> No, children aren't responsible for bills. It can only come from your estate.
I think it's worth noting that while this may be true if you're dead, it's not the case when you're still alive.[1]
Filial responsibility laws mean that adult children can be legally required to pay their impoverished parents' medical bills. The above cites a case where a man was required by the courts to pay $93,000 for his mother's rehabilitation.[2] From what I've read, Pennsylvania may be particularly onerous compared to other states, but it's not a slam dunk kids won't be on the hook.
[1]: https://en.wikipedia.org/wiki/Filial_responsibility_laws
[2]: https://abcnews.go.com/Business/pennsylvania-son-stuck-moms-...
I think it's worth noting that while this may be true if you're dead, it's not the case when you're still alive.[1]
Filial responsibility laws mean that adult children can be legally required to pay their impoverished parents' medical bills. The above cites a case where a man was required by the courts to pay $93,000 for his mother's rehabilitation.[2] From what I've read, Pennsylvania may be particularly onerous compared to other states, but it's not a slam dunk kids won't be on the hook.
[1]: https://en.wikipedia.org/wiki/Filial_responsibility_laws
[2]: https://abcnews.go.com/Business/pennsylvania-son-stuck-moms-...
It's not cut and dry and it requires the company or state to sue. So 'can be' is very unlikely because the laws are not typically enforced. Federal law can also prohibit companies from collecting.
More info is here:
https://www.nolo.com/legal-encyclopedia/your-obligation-pay-...
Because Wikipedia only talks about their existence, not a discussion of them.
More info is here:
https://www.nolo.com/legal-encyclopedia/your-obligation-pay-...
Because Wikipedia only talks about their existence, not a discussion of them.
> It's not cut and dry and it requires the company or state to sue.
I have to imagine that it's pretty rare, and I don't think it's appropriate to generalize from what appears to be a pretty sensationalist case. I expect the laws are usually structured to ensure that children don't fleece their parents out of money and turn them effectively into wards of the state, etc. It doesn't seem unreasonable to me that states would encourage families to take care of each other, though PA seems a bit of an outlier in this regard.
I have to imagine that it's pretty rare, and I don't think it's appropriate to generalize from what appears to be a pretty sensationalist case. I expect the laws are usually structured to ensure that children don't fleece their parents out of money and turn them effectively into wards of the state, etc. It doesn't seem unreasonable to me that states would encourage families to take care of each other, though PA seems a bit of an outlier in this regard.
It's incredibly rare and PA is absolutely an outlier. That's why the case that is mentioned was newsworthy.
Typically when it's used it's to recover money in cases of fraud. For example, where the parent or child conspires to hide money from the state to avoid paying for care. To the best of my knowledge, PA is one of the only states that allows private entities to sue. Some states are like Ohio where it's a criminal statute, so only the state has standing to bring charges. All said, don't get legal advice on the internet, this is an armchair discussion by laypeople.
As an aside, I don't see why the children should have any specific burden to take care of their parents medical expenses now that we have Medicare and Social Security. We've decided it's better to have all of society to take care of our elderly rather than tie it to their children's ability to pay.
Typically when it's used it's to recover money in cases of fraud. For example, where the parent or child conspires to hide money from the state to avoid paying for care. To the best of my knowledge, PA is one of the only states that allows private entities to sue. Some states are like Ohio where it's a criminal statute, so only the state has standing to bring charges. All said, don't get legal advice on the internet, this is an armchair discussion by laypeople.
As an aside, I don't see why the children should have any specific burden to take care of their parents medical expenses now that we have Medicare and Social Security. We've decided it's better to have all of society to take care of our elderly rather than tie it to their children's ability to pay.
I could be wrong, but I thought that the $500K would not count as income for them, but would deduct from your lifetime estate tax exclusion. See https://www.nerdwallet.com/article/taxes/gift-tax-rate
This depends on jurisdiction and the nature of the bills.
Pennsylvania has filial support laws which mean that children can be held directly responsible for the medical expenses of their parents. This requires that Pennsylvania have jurisdiction over the children, of course.
Pennsylvania has filial support laws which mean that children can be held directly responsible for the medical expenses of their parents. This requires that Pennsylvania have jurisdiction over the children, of course.
Is this really true? American health care is a horror show but this is possibly the most messed up thing I’ve heard.
True in some states. Also not just the US. Germany also seems to have some version of filial responsibility.
Filial support laws are not even remotely unique to the US, and it's only true in certain states. Pennsylvania is the most notorious.
France: https://fr.wikipedia.org/wiki/Obligation_alimentaire_en_Fran...
Germany: https://de.wikipedia.org/wiki/Elternunterhalt
Asia has a ton, I'm sure.
France: https://fr.wikipedia.org/wiki/Obligation_alimentaire_en_Fran...
Germany: https://de.wikipedia.org/wiki/Elternunterhalt
Asia has a ton, I'm sure.
I've heard that only the parent needs to live in PA.
This is incorrect.
The parent does not need to live in PA at all, but a suit needs to be brought against the defendant to make them pay, and therefore the court needs to have jurisdiction over that person in order for the lawsuit to succeed.
The parent does not need to live in PA at all, but a suit needs to be brought against the defendant to make them pay, and therefore the court needs to have jurisdiction over that person in order for the lawsuit to succeed.
No, they're not. But hospitals, many times, will absolutely imply that they are when a parent dies in hospital.
And if they do that well enough to have you make a payment, most legal systems will consider that acceptance of full financial responsibility on your part.
And if they do that well enough to have you make a payment, most legal systems will consider that acceptance of full financial responsibility on your part.
My Mom died in 2014, in a local hospital. Several years after her death, I received a bill from that same hospital, addressed to her but sent to my address, for $9K. The kicker is, the "service date" on the bill was 1996! I ignored it since a) she had died; b) she had died in their hospital, so they obviously knew; c) her estate had settled years ago; d) she never received this bill while she was alive.
Hospital billing practice are pretty horrible. If a more compliant person had received this bill, they might have paid it, even though there is no way it was legit.
Hospital billing practice are pretty horrible. If a more compliant person had received this bill, they might have paid it, even though there is no way it was legit.
Yes you can. It just come from your lifetime gift tax exemption.
https://smartasset.com/retirement/gift-tax-limits
https://smartasset.com/retirement/gift-tax-limits
I believe the gift giver is the one who is responsible for any taxes (beyond the $11m threshold). Although if you give gifts as a way to get around debts it might cause issues
Not directly. But if the hospital takes money out of the estate directly, this is in effect taking away from a child's inheritance. Thus, one could interpret this to be "the children paying for the bills"
> imagine your life + childrens’ lives being ruined
A parent’s debts cannot be put on to their children. Once your father died, anything not covered by his estate had to be written off by everyone.
A parent’s debts cannot be put on to their children. Once your father died, anything not covered by his estate had to be written off by everyone.
You are correct about the debt and the parent post clearly knows that, having lived through it'l. However the further point being that any assets that had accumulated with the intention of leaving them to the family, and which they relied on, would have been in jeapordy if they hit probate. If he owned a businessnor a house I'm not sure of the rules, but definitely savings, other assets etc. would be up for grabs.
The rules vary by state and can change depending on if a written will exists.
Parents, talk to an attorney while you're healthy. Some of the states have rules that will surprise you.
Parents, talk to an attorney while you're healthy. Some of the states have rules that will surprise you.
I'm not sure how many people know that though, and the moment you make a payment towards that bill it's legally your debt.
Bear in mind, this can happen to people that have a spouse and underage children. Spouse is decimated, children no longer have any help with collage (assuming they did before that). The family can be left destitute.
true but what of inheritance? I suppose thats what life insurance policies are for.
OP said the father had no assets, so there was no inheritance forthcoming.
If that had happened to my parents, my sibling who lives with them would have lost their home and had to move in with me. Just because OP's situation was different doesn't make that good.
Without knowing anything, 10 million seems excessive, but 6 months in a hospital will no doubt be expensive. I don't want to stir up bad feelings, I'm just curious, was there a good chance that your dad was going to make it out of the hospital? What was EOL talks like with the doctors? This story brings back the article here not too long ago, regarding the average hospital stay of a doctor at EOL vs the general public. I'm not sure of all the influencing factors regarding EOL procedure, but it does seem like a huge amount of resources are used for the very short end of a large amount of people's lives. Once again, no offense intended, it just got me thinking.
Anecdata: I spent 5 days in ICU in 2018 and had a $350k bill from a California hospital, which my insurance company paid $200k for after adjustments and discounts. I wouldn’t say $10m for 6 months is far off.
Yea that sentence came off wrong. I don't doubt the OP's claim at all. I was trying to acknowledge that billing that amount to anyone isn't right and looking to make the point that healthcare is expensive and how "we" choose to allocate resources is an important discussion.
No offense taken. In hindsight, it should have been clear that every day spent in the ICU past 3 months was not a good sign of my dad ever making it out of there. However, we 100% believed he was going to get better all throughout the process. Idk what this assessment was based on, but reflecting back for the first time in a long time, I now realize just how much emotions cloud sensible outlook & probability assessment.
Where did you move to that has better protections for patients regarding health coverage?
10 million USD in 6 months? 10M?
So I immediately imagine an absurd nonsense like "liquid gold transfusion", then I realized it's 800g gold per day in the current gold price.
My pathetic mind can't even imagine the how absurd that is.
So I immediately imagine an absurd nonsense like "liquid gold transfusion", then I realized it's 800g gold per day in the current gold price.
My pathetic mind can't even imagine the how absurd that is.
Was this before 2010?
We (society) cannot afford to pay for everyone's 10 million dollar hospital bills so how do we decide who gets their bills paid?
EDIT: Some argue here that it'll average out, however at what cost to others? [1]Here's article about African Americans getting limbs amputated as their treatment for diabetes.
[1]https://features.propublica.org/diabetes-amputations/black-a...
EDIT: Some argue here that it'll average out, however at what cost to others? [1]Here's article about African Americans getting limbs amputated as their treatment for diabetes.
[1]https://features.propublica.org/diabetes-amputations/black-a...
Most people don't have 10 million dollar hospital bills. That's how insurance works: everyone pays in case something happens to them, and the people who have expensive treatments are subsidized by those who don't.
Insurance is more effective at dispersing that cost when the pool is larger, so the most effective scenario would be for everyone to pay in via taxes and simply… be covered.
Edit: I don't understand the point you're trying to make with your edit.
Insurance is more effective at dispersing that cost when the pool is larger, so the most effective scenario would be for everyone to pay in via taxes and simply… be covered.
Edit: I don't understand the point you're trying to make with your edit.
Rather, were services purchased really worth 10 million dollars?
How much of that are salaries for underperforming, bloated structures in charge of "management" and billing?
How much of that are salaries for underperforming, bloated structures in charge of "management" and billing?
Canadians spend 220k (in 2013) per person per lifetime. It's very unlikely you can shrink 10 million dollar bill to anywhere close to that.
[1]https://www.theglobeandmail.com/life/health-and-fitness/heal...
[1]https://www.theglobeandmail.com/life/health-and-fitness/heal...
What makes Americans that much more expensive than Canadians?
It's mostly end of life care (relative to other countries).
So during your life - broken bones etc - roughly equal.
But if you are stuck in ICU for a year when 75+ - that's uniquely American and incredibly expensive.
"Numerous articles on EOL costs show that a large proportion of Medicare expenditures occur during the last 6 months of life.1-9 This phenomenon has continued for many years as the number of Medicare decedents has increased with the aging American population. Medicare expenditures for EOL have increased dramatically from 1983 to 2016, primarily because of the increase in the number of decedents. Other articles compare EOL expenditures in the United States to other countries10,11 or focus on Medicare expenditures for specific diseases.12-14 A recent development in the literature challenges the idea that EOL costs are responsible for a high percentage of health-care costs.15
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6610551/
So during your life - broken bones etc - roughly equal.
But if you are stuck in ICU for a year when 75+ - that's uniquely American and incredibly expensive.
"Numerous articles on EOL costs show that a large proportion of Medicare expenditures occur during the last 6 months of life.1-9 This phenomenon has continued for many years as the number of Medicare decedents has increased with the aging American population. Medicare expenditures for EOL have increased dramatically from 1983 to 2016, primarily because of the increase in the number of decedents. Other articles compare EOL expenditures in the United States to other countries10,11 or focus on Medicare expenditures for specific diseases.12-14 A recent development in the literature challenges the idea that EOL costs are responsible for a high percentage of health-care costs.15
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6610551/
I am aware that EOL care is a large part of the costs of our system. However, one thing I have not heard is any definitive evidence that that is materially different in the US vs. e.g. Canada or the UK.
This study suggests that your interpretation is not correct: https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.0174 Mean end of life spending is only marginally higher in the U.S. than in other countries.
This study suggests that your interpretation is not correct: https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.0174 Mean end of life spending is only marginally higher in the U.S. than in other countries.
I thought something like 25% of medicare spending was in last year of life spending.
I've also heard that something like 5% of folks generate 50% of costs.
So the argument has been that because in the US total expenditure can go so high (ie, we will easily spend $10M on one person where other countries won't) that you end up with a serious spike as a result of last year of life and extraordinary effort costs.
Other countries have less variance (including income inequality)
I've also heard that something like 5% of folks generate 50% of costs.
So the argument has been that because in the US total expenditure can go so high (ie, we will easily spend $10M on one person where other countries won't) that you end up with a serious spike as a result of last year of life and extraordinary effort costs.
Other countries have less variance (including income inequality)
Yep, I'm aware of the argument, and I think you've stated it correctly. But the data I was able to find does not seem to support it.
From the study (~1980 data) [1]:
Cost of care in the last year of life in USA varied from study to study, between US$40,000 to US$95,776.
Extrapolated cost for Canada: 6,758.2
[1]https://www.longwoods.com/content/20878/healthcare-quarterly...
Extrapolated cost for Canada: 6,758.2
[1]https://www.longwoods.com/content/20878/healthcare-quarterly...
That number is the total cost for all people who died in Canada, extrapolated from Saskatchewan data, in millions of dollars. 6.7B dollars, that is. Considering something like 300k people die in Canada each year, that's around 20k per capita. (This is seriously mixing units because the population of Canada has increased a lot since the study you cited.)
In any case, it's not the correct number. Quebec data from the study I cited showed 60k per capita on hospital alone, with incomplete data to characterize the remainder of the costs.
In any case, it's not the correct number. Quebec data from the study I cited showed 60k per capita on hospital alone, with incomplete data to characterize the remainder of the costs.
> At what cost to others?
Assuming nothing else changes, it'll about double the cost of what people pay now for private insurance (in terms of taxes).
However, there's no reason to assume nothing else changes. The US spends an atrocious amount on the overhead of bookkeeping our "free-market" semi-adversarial healthcare system. Estimates over the past 22 years range from 13 to 25% of the cost is raw administration. Assume most of that cost goes away (let's say 90%, which seems fair) and you're left with Americans paying about $250-400 a month more on average in taxes for healthcare than what is paid now.
Since it's taxes, the progressive tax rate would kick in and this would translate overall to most Americans paying almost nothing more, the middle class getting squeezed (this could be ameliorated with laws, but if nothing else changes the middle class gets squeezed), and the wealthy and super-wealthy shouldering the bulk of the cost.
Assuming nothing else changes, it'll about double the cost of what people pay now for private insurance (in terms of taxes).
However, there's no reason to assume nothing else changes. The US spends an atrocious amount on the overhead of bookkeeping our "free-market" semi-adversarial healthcare system. Estimates over the past 22 years range from 13 to 25% of the cost is raw administration. Assume most of that cost goes away (let's say 90%, which seems fair) and you're left with Americans paying about $250-400 a month more on average in taxes for healthcare than what is paid now.
Since it's taxes, the progressive tax rate would kick in and this would translate overall to most Americans paying almost nothing more, the middle class getting squeezed (this could be ameliorated with laws, but if nothing else changes the middle class gets squeezed), and the wealthy and super-wealthy shouldering the bulk of the cost.
I think a piece that you're missing here is that health problems get drastically worse, and more expensive to fix, when they're not addressed.
Problems are often not addressed in a reasonable time frame because many people don't have access to reasonable health care. Even they they do, they may be hesitate to use it. Anecdotally, last time I went for a preventative check, I was given an FAQ sheet when I signed in reminding me that if I ask about anything specific, or diagnostic, that is not preventative (as if I'm supposed to understand the difference), then it would have to be billed separately and may-or-may-not be covered by my insurance. That was almost enough for me to not ask my doctor questions while I was at the office.
I would imagine that more widely addressing issues early on before they become expensive would remove another large portion of overall US healthcare costs.
Problems are often not addressed in a reasonable time frame because many people don't have access to reasonable health care. Even they they do, they may be hesitate to use it. Anecdotally, last time I went for a preventative check, I was given an FAQ sheet when I signed in reminding me that if I ask about anything specific, or diagnostic, that is not preventative (as if I'm supposed to understand the difference), then it would have to be billed separately and may-or-may-not be covered by my insurance. That was almost enough for me to not ask my doctor questions while I was at the office.
I would imagine that more widely addressing issues early on before they become expensive would remove another large portion of overall US healthcare costs.
Not everyone is going to have a 10 million dollar hospital bill. That's the entire point of insurance, and also the point of having a national plan: you generally aren't going to know if you're going to have a lifetime expense of 10K or 10M. So you need to aggregate that across the entire population.
Other countries seem to manage it.
Why? Works ok in Australia.
Out-of-network was always just a sketchy way for insurance to avoid paying what they should have paid.
Let's say you get a hypothetical procedure. Insurance has already agreed to pay in-network providers between $1-3K for this procedure. But you got this procedure out-of-network. Why is insurance's liability suddenly $0 instead of whatever the lowest in-network fee schedule would be ($1K in this example)?
See I can understand insurance not wanting to foot substantially higher bills than in-network providers charge, but I cannot understand why it drops to $0 reimbursed when you leave network. It seems like an immoral "gotcha."
But then again I'd like to see insurance discounts/agreements banned. Make everything and nothing in-network and also normalize the insured/uninsured prices. No more "$100 for a band-aid, -$99 discount" shenanigans.
Obviously single-payer would be better yet still, but if we must keep using this broken private employer-linked insurer system let us at least keep band-aid fixing it until we can get enough political support to scrap it.
Let's say you get a hypothetical procedure. Insurance has already agreed to pay in-network providers between $1-3K for this procedure. But you got this procedure out-of-network. Why is insurance's liability suddenly $0 instead of whatever the lowest in-network fee schedule would be ($1K in this example)?
See I can understand insurance not wanting to foot substantially higher bills than in-network providers charge, but I cannot understand why it drops to $0 reimbursed when you leave network. It seems like an immoral "gotcha."
But then again I'd like to see insurance discounts/agreements banned. Make everything and nothing in-network and also normalize the insured/uninsured prices. No more "$100 for a band-aid, -$99 discount" shenanigans.
Obviously single-payer would be better yet still, but if we must keep using this broken private employer-linked insurer system let us at least keep band-aid fixing it until we can get enough political support to scrap it.
Totally agreed. My favorite is when you add this scenario to physically being somewhere without any in-network doctors.
I cut my hand open climbing in northern New Mexico, bandaids and gauze weren't stopping the bleeding, so I went to the nearest town clinic/urgent care. Ultimately got 8 stitches.
My insurance denied (almost) everything. They would later explain that I was supposed to drive myself several hours to Albuquerque to get my hand looked at instead.
I say almost because the covered $70 for the lidocaine shot, but literally nothing else. Why they deemed the lidocaine necessary but not the stitches could not be explained. Clearly they had a way to pay the clinic, so wasn't that.
Another whacky thing I discovered: the insurance company gets to decide how much, if any, of your uncovered, out-of-pocket bill counts towards your deductible. In this case they deemed $109 of $832 to be the right number, with no explanation as to how they arrived at that sum.
I cut my hand open climbing in northern New Mexico, bandaids and gauze weren't stopping the bleeding, so I went to the nearest town clinic/urgent care. Ultimately got 8 stitches.
My insurance denied (almost) everything. They would later explain that I was supposed to drive myself several hours to Albuquerque to get my hand looked at instead.
I say almost because the covered $70 for the lidocaine shot, but literally nothing else. Why they deemed the lidocaine necessary but not the stitches could not be explained. Clearly they had a way to pay the clinic, so wasn't that.
Another whacky thing I discovered: the insurance company gets to decide how much, if any, of your uncovered, out-of-pocket bill counts towards your deductible. In this case they deemed $109 of $832 to be the right number, with no explanation as to how they arrived at that sum.
The only similar thing I know in the EU is needing medical care abroad, meaning out side the country you are living in (more accurate, the country you are insured in). Then it can be scetchy, especially if certain procedures are not accepted in your country. But even then you only pay the difference, you have in some cases, pay upfront before you get reimbursed by your insurance. These differences tend to be rather small. Again from a German perspective, supplemental insurance for travel (global, including repatriation flights if necessary, and even helicopter evac) is very affordable. E.g. through the ADAC, the German automobile club.
Ot is even possible for German citizens living abroad (I think outside the EU) to pay into a special insurance to maintain the German health insurance. Around 100 bucks or so, but I would have to read up on it again. Which is nice, e.g. because you travel full time or are an expat (the US comes to mind).
Edit: That's one provider, the 1 year plan is 35 Euro, ythe 5 year plan 59 per month.
https://www.hansemerkur.de/langfristige-auslandskrankenversi...
EDIT 2: Including the US and Canada prices increase by roughly 3 fold.
Ot is even possible for German citizens living abroad (I think outside the EU) to pay into a special insurance to maintain the German health insurance. Around 100 bucks or so, but I would have to read up on it again. Which is nice, e.g. because you travel full time or are an expat (the US comes to mind).
Edit: That's one provider, the 1 year plan is 35 Euro, ythe 5 year plan 59 per month.
https://www.hansemerkur.de/langfristige-auslandskrankenversi...
EDIT 2: Including the US and Canada prices increase by roughly 3 fold.
Should probably have gone to an ER. Emergencies are easier to argue and appeal. "Urgent" (yet less costly) and they assume you still could have waited... it wasn't an emergency yet. I hate our insurance/medical payment/determination system. It's a joke.
>Should probably have gone to an ER. Emergencies are easier to argue and appeal.
ER visits for emergencies are also covered as in-network care under the ACA, even if you're half way across the country. I know cuz I was 1500 miles into a road trip when I went to the ER. My insurance covered it as in-network.
ER visits for emergencies are also covered as in-network care under the ACA, even if you're half way across the country. I know cuz I was 1500 miles into a road trip when I went to the ER. My insurance covered it as in-network.
They're looking at clamping down on that, too.
https://arstechnica.com/science/2021/06/biggest-health-insur...
> Doctors and hospitals are condemning plans by UnitedHealthcare—the country’s largest health insurance company—to retroactively deny emergency medical care coverage to members if UHC decides the reason for the emergency medical care wasn’t actually an emergency.
https://arstechnica.com/science/2021/06/biggest-health-insur...
> Doctors and hospitals are condemning plans by UnitedHealthcare—the country’s largest health insurance company—to retroactively deny emergency medical care coverage to members if UHC decides the reason for the emergency medical care wasn’t actually an emergency.
This was my experience as well. I went to the ER with tremendous chest pain, it turns out I have some issue with my ribcage. Not my heart. UHC decided I did not in fact need to see a cardiologist or an ECG since I wasn't having a heart attack and declined to pay for anything.
Multiple attempts on my part to resolve this yielded nothing. I contacted the state of TX, who brought suit against both parties (insurance & service provider). Somehow, the day before the court appearance they all agreed to settle the claim at no cost to me.
Multiple attempts on my part to resolve this yielded nothing. I contacted the state of TX, who brought suit against both parties (insurance & service provider). Somehow, the day before the court appearance they all agreed to settle the claim at no cost to me.
Good on you for being persistent.
Perhaps unsurprisingly, I do indeed have United Healthcare.
I went to an in-network urgent care for a particularly painful pinched nerve and got worthless drugs, and the uncovered part of the bill came out more than the covered part. Next time I'll just suffer at home and hope I don't die. It'll amount to the same result.
The nearest ER was still much, much farther away than the urgent care facility. I would have undoubtedly put myself at more risk by trying to drive a vehicle down a highway for an hour.
Thankfully the bill I did receive was somewhat reasonable, and I was able to pay it without much issue.
Thankfully the bill I did receive was somewhat reasonable, and I was able to pay it without much issue.
Given the location and possible severity, the only viable way to an emergency room might have been a helicopter. Which insurance almost certainly would not cover.
So the insurance is saying "If you paid $80,000 for a medevac, we would have covered your hospital bill".
So the insurance is saying "If you paid $80,000 for a medevac, we would have covered your hospital bill".
Hell, a few years ago UHC made the news because they were denying coverage for Flight EMS from serious car accidents due to "lack of pre-authorization".
I believe they count what it would have been in-network.
As for saying you should have driven hours with bleeding you couldn't stop--do you have any sort of appeal process? That certainly doesn't sound right.
As for saying you should have driven hours with bleeding you couldn't stop--do you have any sort of appeal process? That certainly doesn't sound right.
It's pretty common for providers not to cover anything except ER visits, out of your home state. And that only because (I think) they're required to. And I bet they interpret that as narrowly as possible ("heart attack, went to the ER, but then moved to a bed in a normal room? We'll cover the ER care but not the room or any care that took place there, have fun with bankruptcy").
An urgent care might not count.
An urgent care might not count.
> Another whacky thing I discovered: the insurance company gets to decide how much, if any, of your uncovered, out-of-pocket bill counts towards your deductible. In this case they deemed $109 of $832 to be the right number, with no explanation as to how they arrived at that sum.
Not that I think much of the likelihood of success, but aren't you, for any such decisions, entitled to (a) receive a justification on request, and (b) appeal that decision?
Not that I think much of the likelihood of success, but aren't you, for any such decisions, entitled to (a) receive a justification on request, and (b) appeal that decision?
Screwing around with insurance process bullshit can easily exceed the value of whatever you're trying to regain/figure-out.
Hours, literally, of on-hold time, likely more than once, and if you're trying to get them to pay for something they don't want to, you're likely going to need to get state regulators or lawyers involved, which means even more time (and money, in the latter case). Probably you'll end up having to do the same thing with one or more hospitals or healthcare providers, playing go-between with them and insurance, and usually those places subject you to the same malicious-incompetence as the insurer does.
Hours, literally, of on-hold time, likely more than once, and if you're trying to get them to pay for something they don't want to, you're likely going to need to get state regulators or lawyers involved, which means even more time (and money, in the latter case). Probably you'll end up having to do the same thing with one or more hospitals or healthcare providers, playing go-between with them and insurance, and usually those places subject you to the same malicious-incompetence as the insurer does.
Yes, but when the insurance company controls the appeals process, they will likely deny it.
You can theory-craft a non-malicious justification: Insurance trusts Dr. Hibbert will perform the procedure without complications and has negotiated a fixed price of $1K. Insurance doesn't trust Dr. Nick and believes any procedure he performs will result in a second claim later to set things right. Insurance strongly wants you to chose Dr. Hibbert and the only leverage they have is to refuse to pay for Dr. Nick should you go with him.
Not sure how plausible that is though--I suppose they could data-mine frequency of follow-up treatment required per doctor--but I've never observed in network/out of network to correspond to a meaningful metric (our local dentist recommended by all the dental specialists around doesn't deal with any insurance companies, while the in-network dentist is pretty clearly padding their work)
Not sure how plausible that is though--I suppose they could data-mine frequency of follow-up treatment required per doctor--but I've never observed in network/out of network to correspond to a meaningful metric (our local dentist recommended by all the dental specialists around doesn't deal with any insurance companies, while the in-network dentist is pretty clearly padding their work)
Why doesn't the insurance company trust Dr. Nick?
If there's reason to not trust Dr. Nick, then surely the insurance company must disclose it. If there's reason to not trust Dr. Nick, then surely Dr. Nick would have trouble maintaining a medical license. If there's reason to not trust Dr. Nick then surely Dr. Nick's own malpractice insurance would become too onerous for him to keep.
No, this smells exactly like what @Someone1234 stated:
> Out-of-network was always just a sketchy way for insurance to avoid paying what they should have paid.
If there's reason to not trust Dr. Nick, then surely the insurance company must disclose it. If there's reason to not trust Dr. Nick, then surely Dr. Nick would have trouble maintaining a medical license. If there's reason to not trust Dr. Nick then surely Dr. Nick's own malpractice insurance would become too onerous for him to keep.
No, this smells exactly like what @Someone1234 stated:
> Out-of-network was always just a sketchy way for insurance to avoid paying what they should have paid.
Sometimes the trust issue is more about fraudulent claims than one's ability to practice medicine...
Then why is he still in business? If he's committing insurance fraud, then the insurance company should work with regulators to stop and potentially prosecute him. The onus to prevent fraud should not be on me as a patient.
> If there's reason to not trust Dr. Nick, then surely the insurance company must disclose it.
That should include "we think Dr. Nick makes fraudulent claims"
That should include "we think Dr. Nick makes fraudulent claims"
Yeah. There is a legitimate quality reason but it doesn't appear to be how they actually operate. Reality is more like a local case that resulted in a lawsuit (never heard the outcome) against the insurance company for sending patients to your Dr. Nick.
I mean, Dr. Hibbert might refuse to be in network for some insurance company because he doesn't like their rates. I think that's more common
I'm not defending it, but there is actually a logical justification here -- it's not just insurance companies being evil.
When insurance companies sign up doctors to their network, doctors agree to lower fees (lower profit) but expect to make it up in volume, because the health plan will send them more patients.
But that only works if patients are made to stay in-network, which produces the guaranteed volume. So health care plans won't pay if you go out of network. The economics would fall apart otherwise -- plans wouldn't be able to negotiate the lower prices because a doctor's office wouldn't see any uptick in volume.
Now it depends on the plan, but there are often exceptions for when you're traveling and need emergency care -- they'll pay network rates toward that because it's not a visit that an in-network doctor would have lost.
Also, plenty of "gold-plated" plans will cover anything out-of-network as well -- because they're expensive plans they're willing to pay doctors more, and so don't need to provide doctors with volume.
When insurance companies sign up doctors to their network, doctors agree to lower fees (lower profit) but expect to make it up in volume, because the health plan will send them more patients.
But that only works if patients are made to stay in-network, which produces the guaranteed volume. So health care plans won't pay if you go out of network. The economics would fall apart otherwise -- plans wouldn't be able to negotiate the lower prices because a doctor's office wouldn't see any uptick in volume.
Now it depends on the plan, but there are often exceptions for when you're traveling and need emergency care -- they'll pay network rates toward that because it's not a visit that an in-network doctor would have lost.
Also, plenty of "gold-plated" plans will cover anything out-of-network as well -- because they're expensive plans they're willing to pay doctors more, and so don't need to provide doctors with volume.
It kind of depends on the network. For a real owned and operated HMO where every provider in the network buildings and offices is an employee of the network (or under contract as a network provider), in-network only (for non-emergency services) makes a lot of sense to control costs, make staffing predictable, ensure consistency of care, etc. As an insured, you go to one building and get everything taken covered. If you want to go out of network for something, you need a good reason or be willing to pay for the whole thing.
When it's a third party HMO network and you've got stuff like a medical office where only some doctors are in network and others aren't, so if your doctor is behind or out sick and you're offered to see another doctor in the interest of time and then you've seen an out of network doctor, that's a totally different deal. Then you've got things like in-office X-ray analyzed by an off-site radiologist whose identity and network status wasn't known before hand.
I'd like to see non-emergency medicine take up the same kind of quoting requirements as auto repair. You can't always stop a procedure to update the quote, so provide several quotes for the likely outcomes.
When it's a third party HMO network and you've got stuff like a medical office where only some doctors are in network and others aren't, so if your doctor is behind or out sick and you're offered to see another doctor in the interest of time and then you've seen an out of network doctor, that's a totally different deal. Then you've got things like in-office X-ray analyzed by an off-site radiologist whose identity and network status wasn't known before hand.
I'd like to see non-emergency medicine take up the same kind of quoting requirements as auto repair. You can't always stop a procedure to update the quote, so provide several quotes for the likely outcomes.
The issue with single payer is all the special interests that already make our costs the highest in the world would lobby to make that single payer pay more. We have this already. Medicare cannot by law negotiate drug prices despite probably being the largest single payer.
The out of network provider in an in network hospital is probably the most perverse thing to happen. One could be unconscious at a hospital and have out of network provider Dr Smith LLC stop in for a few minutes and send you her own bill.
The out of network provider in an in network hospital is probably the most perverse thing to happen. One could be unconscious at a hospital and have out of network provider Dr Smith LLC stop in for a few minutes and send you her own bill.
Just a note, it's possible to lose money accepting some Medicaid insurances. Specifically if you need to hire a translator.
$40/hr payout for physical therapy + translator contactor.
$40/hr payout for physical therapy + translator contactor.
It typically doesn’t drop to $0?
At least all the insurance I’ve had will pay using some formula like “we will cover 80% (instead of 90%) of charges up to the allowed amount (what an in-network would receive”.
The issue is that many providers balance bill, so everything above that is billed to the patient and since some negotiated rates are 50% or less of charges, the patient can own more than the insurance.
Basically insurance and providers fuck over the patients together.
At least all the insurance I’ve had will pay using some formula like “we will cover 80% (instead of 90%) of charges up to the allowed amount (what an in-network would receive”.
The issue is that many providers balance bill, so everything above that is billed to the patient and since some negotiated rates are 50% or less of charges, the patient can own more than the insurance.
Basically insurance and providers fuck over the patients together.
I can't think of any other industry where it's normal to charge different customers different prices for the same good/service.
The insurance companies own the networks. So it's a way for them to pay themselves rather than pay externally.
I once called 911 when my wife had an Asthma attack that left her unable to speak or stand. She was transfered from an ambulance to a paramedic about half way to the hospital. My insurance covered one as in-network but not the other. My wife was released a few hours later. I was young and it took me about 10 years to pay off the dept I owed. I am extremely hesitant to call an ambulance if the person can be encouraged to move under their own power. So much so, that I was asked to sign papers when a family physician suggested an ambulance. This rule looks like it helps.
That is just crazy. Two years ago my son had a skiing accident. Was evacuated from the mountain by mountain guards, picked up by an ambulance, driven one hour to the next hospital, examined by a doctor and got an x-ray. 6 months later we received an invoice from our public (semi-public, the German system is peculiar) about 30 bucks (if memory serves well) for all of this. And that was mainly the longer distance ambulance ride.
Nobody should be afraid of calling an ambulance. Nobody should need ten years to pay debts for medical care, regardless of procedure.
Another example, age 28 I was diagnosed with colon cancer. That meant a shit load of colonoscopies since then, removal of parts of the colon and 6 months chemotherapy. Overall bill: around 50 bucks per months for the chemotherapy. Luckily I had supplemental insurance covering my salary, also my employer back then continued to pay after the legal 6 weeks. The risk you run in Germany is loosing your salary after 6 weeks, making that salary insurance so important. It is also dirt cheap, I pay roughly 15 bucks a month, it never increased since my studies. Health care should be a human right.
Nobody should be afraid of calling an ambulance. Nobody should need ten years to pay debts for medical care, regardless of procedure.
Another example, age 28 I was diagnosed with colon cancer. That meant a shit load of colonoscopies since then, removal of parts of the colon and 6 months chemotherapy. Overall bill: around 50 bucks per months for the chemotherapy. Luckily I had supplemental insurance covering my salary, also my employer back then continued to pay after the legal 6 weeks. The risk you run in Germany is loosing your salary after 6 weeks, making that salary insurance so important. It is also dirt cheap, I pay roughly 15 bucks a month, it never increased since my studies. Health care should be a human right.
> we received an invoice from our public (semi-public, the German system is peculiar) about 30 bucks (if memory serves well) for all of this
Honestly, it's remarkable how different it is here across the border here in Switzerland. An ambulance was called to me within the same city from a few km away (although I was across the street from the main hospital), performed an ECG/EKG on me, didn't pick me up or transport me anywhere, and I was billed about 700 bucks for that privilege.
Honestly, it's remarkable how different it is here across the border here in Switzerland. An ambulance was called to me within the same city from a few km away (although I was across the street from the main hospital), performed an ECG/EKG on me, didn't pick me up or transport me anywhere, and I was billed about 700 bucks for that privilege.
I honestly wouldn't have expected that. There was a time when ranting about the German system was a favourite pastime, and there a lot of ridiculous and annoying things going on, but the more I learn about other countries I actually am quite happy, or better lucky.
Ugh, that's horrible, sorry to hear that.
Note that ground ambulances are excluded from the legislation that Congress passed last year, cf. https://www.nytimes.com/2020/12/22/upshot/ground-ambulances-....
Note that ground ambulances are excluded from the legislation that Congress passed last year, cf. https://www.nytimes.com/2020/12/22/upshot/ground-ambulances-....
Yup--gotta let the mostly government funded ambulances shaft the patients.
No kidding.
"Family Gets $18,000 Hospital Bill After Their Son Was Treated with a Bottle of Formula and a Nap"
That kind of stuff stresses folks out!
"Family Gets $18,000 Hospital Bill After Their Son Was Treated with a Bottle of Formula and a Nap"
That kind of stuff stresses folks out!
A good health system should deliver better quality of life to all the people of the country. That includes not just doing actual health, but acting as an insurance, giving actual peace of mind - if something happens, it might not be the end of the world.
Wait, that's not the Onion?
Unfortunately not. And at it happened at Zuckerberg SF General Hospital. Somehow seems inappropriately appropriate....
https://abc7news.com/zuckerberg-san-francisco-general-hospit...
https://abc7news.com/zuckerberg-san-francisco-general-hospit...
This bill misses a big point. IMO should be there is only one price. Insured, in/out of network, regardless. A lot of times the reason an out of network rate is so high is because these providers are charging so much more for the same thing.
Additionally it seems we have a supply vs demand issue if healthcare providers have such pricing power. Maybe it's time to open up the training supply and let folks with a 3.3GPA become doctors?
EDIT: looks like maybe the supply issue is more about residency than med school https://www.fiercehealthcare.com/practices/more-medical-stud...
Additionally it seems we have a supply vs demand issue if healthcare providers have such pricing power. Maybe it's time to open up the training supply and let folks with a 3.3GPA become doctors?
EDIT: looks like maybe the supply issue is more about residency than med school https://www.fiercehealthcare.com/practices/more-medical-stud...
I wrote Hacking Healthcare for Orielly, created ClearHealth, yada yada...
Devil is always in the details of these rules but on the surface it looks like a good attempt. It is a sort of a bandaid though.
To understand why this occurs know that most jurisdictions have certain staffing requirements for service lines. You must have X many neurologists covering X shifts. There is almost universally a shortage of these folks for other reasons, so you end up with a lot of non-staff doctors to fill the coverage requirements. Those non-staff often have different insurance relationships than staff doctors and so are "out of network".
The two serious changes that would have a more durable impact on this are to free the lock the AMA has on residencies that exacerbates doctor shortages and to dramatically streamline the way insurance program enrollment is done for doctors. Further opening up interstate health insurance would also probably help.
Devil is always in the details of these rules but on the surface it looks like a good attempt. It is a sort of a bandaid though.
To understand why this occurs know that most jurisdictions have certain staffing requirements for service lines. You must have X many neurologists covering X shifts. There is almost universally a shortage of these folks for other reasons, so you end up with a lot of non-staff doctors to fill the coverage requirements. Those non-staff often have different insurance relationships than staff doctors and so are "out of network".
The two serious changes that would have a more durable impact on this are to free the lock the AMA has on residencies that exacerbates doctor shortages and to dramatically streamline the way insurance program enrollment is done for doctors. Further opening up interstate health insurance would also probably help.
>Further opening up interstate health insurance would also probably help.
Can't wait to race to the bottom on this one. Which state wants to roll out the red carpet for insurers most? If I ever have a problem with Montana BCBS I'm sure, once I fly over, I'll be able to explain to the arbitrator in Butte exactly what my issues are and get a fair hearing.
Can't wait to race to the bottom on this one. Which state wants to roll out the red carpet for insurers most? If I ever have a problem with Montana BCBS I'm sure, once I fly over, I'll be able to explain to the arbitrator in Butte exactly what my issues are and get a fair hearing.
Hahaha I'm not holding my breath.
It's multiple cartels vs us.
These cartels have spent literally 2 billion dollars on lobbying politicians.
So the real question is, how does this hurt us? How is this helping physicians build mansions, hospitals get record profits, etc...
It's multiple cartels vs us.
These cartels have spent literally 2 billion dollars on lobbying politicians.
So the real question is, how does this hurt us? How is this helping physicians build mansions, hospitals get record profits, etc...
This doesn't hurt you directly, it's meant to placate people from demanding a substantial solution.
Don’t forget sports cars and yachts are expensive too.
With the number of mass shootings we have in America, I'm surprised I've never seen a story about a terminally ill person with astronomical medical debt going on a rampage at their insurance company's corporate office.
Would probably make for a good movie concept - kind of a modernization of Falling Down.
Would probably make for a good movie concept - kind of a modernization of Falling Down.
Wow, on the face this looks like a really great rule. I suspect there's going to be an ton of irate specialists (especially anesthesiologists) who were making fortunes from surprise billing.
We took our son to an emergency room visit 2 1/2 years ago. The hospital was in network and we had insurance. It was a simple case of croup, we were out in a few hours.
We just got a bill last month for $300. This was on top of 3 other bills we have already paid over the years for the same visit.
The insurance company said they only knew about it a few days before us. So it was a surprise to them too. But by nature of their agreement with the hospital, they were not allowed to fight it.
I still wonder how many more bills we can expect.
We just got a bill last month for $300. This was on top of 3 other bills we have already paid over the years for the same visit.
The insurance company said they only knew about it a few days before us. So it was a surprise to them too. But by nature of their agreement with the hospital, they were not allowed to fight it.
I still wonder how many more bills we can expect.
From the announcement:
"Bans high out-of-network cost-sharing for emergency and non-emergency services. Patient cost-sharing, such as co-insurance or a deductible, cannot be higher than if such services were provided by an in-network doctor, and any coinsurance or deductible must be based on in-network provider rates."
This to me seems to just completely eliminate the difference between in-network and out-of-network billing. What am I missing?
"Bans high out-of-network cost-sharing for emergency and non-emergency services. Patient cost-sharing, such as co-insurance or a deductible, cannot be higher than if such services were provided by an in-network doctor, and any coinsurance or deductible must be based on in-network provider rates."
This to me seems to just completely eliminate the difference between in-network and out-of-network billing. What am I missing?
My read of the fourth bullet is that if you're receiving non-emergency service from an out-of-network provider, they can still balance bill you as long as you've signed the plain-language consent. (Presumably with such signature being a pre-requisite to receiving services.)
Agreed. They are making in network and out of network the same from the the cost sharing perspective. To avoid screwing over out of network providers, they allow out of network balance billing, but only with consent.
The actual rule also goes into things like consent to be balance billed for your knee surgery, is not consent to be balance billed for the ICU care when that surgery goes wrong and you nearly bleed out, and suffer major organ damage, etc...
This consent option is not always available, an in those circumstances, balance billing is simply prohibited, and in network and out of network are fully equivlent in those cases from a patients' perspective.
The actual rule also goes into things like consent to be balance billed for your knee surgery, is not consent to be balance billed for the ICU care when that surgery goes wrong and you nearly bleed out, and suffer major organ damage, etc...
This consent option is not always available, an in those circumstances, balance billing is simply prohibited, and in network and out of network are fully equivlent in those cases from a patients' perspective.
I don't love this solution to the problem.
This doesn't help anyone paying cash for services, and it really just invests more into the current broken system.
I think the solution is that all healthcare providers must provide upfront pricing for you.
Right now, almost all medical billing is surprise billing. It's basically the only sector where this is true.
This doesn't help anyone paying cash for services, and it really just invests more into the current broken system.
I think the solution is that all healthcare providers must provide upfront pricing for you.
Right now, almost all medical billing is surprise billing. It's basically the only sector where this is true.
Agreed. I think the biggest problem is that the providers themselves are as much in the dark as the customers when it comes to knowing what insurance will actually pay. So they submit some highball number and see what comes back. I think what is needed more than anything else is to require insurers to provide an API to providers that will give a legally binding coverage quote instantly, before services are provided, not months later.
There will be some qualifiers to that, like the provider must indicate what conditions the patient is being treated for to qualify for the procedure, and if the patient doesn't actually have that condition, then whoever falsified the information (or was grossly negligent in diagnosing) is stuck with the bill.
Once that is in place, then you can require the providers to give quotes beforehand.
There will be some qualifiers to that, like the provider must indicate what conditions the patient is being treated for to qualify for the procedure, and if the patient doesn't actually have that condition, then whoever falsified the information (or was grossly negligent in diagnosing) is stuck with the bill.
Once that is in place, then you can require the providers to give quotes beforehand.
> Bans other out-of-network charges without advance notice. Health care providers and facilities must provide patients with a plain-language consumer notice explaining that patient consent is required to receive care on an out-of-network basis before that provider can bill at the higher out-of-network rate.
This seems like a really big loophole. I was just at the hospital for the birth of my daughter. My wife and I checked in at the OB desk where they asked for acknowledgment that we may be seen physicians that aren't part of the hospital (out of network).
We acknowledged, so surprise medical bills are fair game now?
This seems like a really big loophole. I was just at the hospital for the birth of my daughter. My wife and I checked in at the OB desk where they asked for acknowledgment that we may be seen physicians that aren't part of the hospital (out of network).
We acknowledged, so surprise medical bills are fair game now?
It's straight up not possible to be an informed consumer in the US and avoid this stuff when it comes to health insurance.
There's no market of rational decision makers, no choices you can make and really know the outcome when it comes to health insurance.
My health insurance is pretty good and yet they randomly send me letters saying that they think the procedure should be covered by some other insurance they THINK I might have.
In the meantime they stop covering things and the providers send me bills with no health insurance coverage ....
They do this about every 18 months, I think hoping I just pay the bills and not notice.
There's no market of rational decision makers, no choices you can make and really know the outcome when it comes to health insurance.
My health insurance is pretty good and yet they randomly send me letters saying that they think the procedure should be covered by some other insurance they THINK I might have.
In the meantime they stop covering things and the providers send me bills with no health insurance coverage ....
They do this about every 18 months, I think hoping I just pay the bills and not notice.
One time I called my insurance to check if they would cover something that I could only find an out-of-network provider for.
They said that I had out-of-network coverage after a $750 deductible they would pick up 80% and I would be responsible for 20%.
The out-of-network provider had quoted me $6700 for the service, so my responsibility should be $750 + (20% * ($6700 - $750)) = $750 + $1,190 = $1,940.
I wasn't happy about having to shell out nearly two grand while having the best possible employer provided healthcare, Anthem PPO where we paid the most per month to have low deductibles and high coverage.
At the end of the call, I tell the insurance company my understanding of what my responsibility is and what their responsibility is. Then they drop this on me, "Well we will pay 80% of the allowable price for the billing code the out-of-network provider submits."
Good thing I asked, this was the first time they said anything about an "allowable price" so I describe the service and ask "what's the allowable price for that?"
"Depends on how they code it"
So I go back to the out-of-network provider and ask them for the billing code, which being a doctor that doesn't do their own billing, they have no idea. So I wait a few weeks to get back the billing code, and I'm back on the phone with my insurance company.
"Hey, I have this billing code someone out-of-network will be doing, what's the allowable price on this?"
"We can't tell you that, you'll have to submit a claim."
"But when I submit the claim you will have this billing code and my member id and you will know the allowable price so you can figure out how much you are going to pay, you have that information now. What's the allowable price for this billing code, performed by someone out-of-network, with my plan?"
It took them 2 weeks to come back and say that their "allowable price" was $1,658.
So to summarize, it took me nearly two months of phone calls between myself, the insurance company, and the provider to find out what this service would actually cost. I only avoided accidentally getting hit by a massive surprise bill because of a combination of persistence and luck.
It is nearly impossible to have any reasonable idea how much anything will cost, much less to comparison shop, when it takes months to get answers to basic questions.
They said that I had out-of-network coverage after a $750 deductible they would pick up 80% and I would be responsible for 20%.
The out-of-network provider had quoted me $6700 for the service, so my responsibility should be $750 + (20% * ($6700 - $750)) = $750 + $1,190 = $1,940.
I wasn't happy about having to shell out nearly two grand while having the best possible employer provided healthcare, Anthem PPO where we paid the most per month to have low deductibles and high coverage.
At the end of the call, I tell the insurance company my understanding of what my responsibility is and what their responsibility is. Then they drop this on me, "Well we will pay 80% of the allowable price for the billing code the out-of-network provider submits."
Good thing I asked, this was the first time they said anything about an "allowable price" so I describe the service and ask "what's the allowable price for that?"
"Depends on how they code it"
So I go back to the out-of-network provider and ask them for the billing code, which being a doctor that doesn't do their own billing, they have no idea. So I wait a few weeks to get back the billing code, and I'm back on the phone with my insurance company.
"Hey, I have this billing code someone out-of-network will be doing, what's the allowable price on this?"
"We can't tell you that, you'll have to submit a claim."
"But when I submit the claim you will have this billing code and my member id and you will know the allowable price so you can figure out how much you are going to pay, you have that information now. What's the allowable price for this billing code, performed by someone out-of-network, with my plan?"
It took them 2 weeks to come back and say that their "allowable price" was $1,658.
So to summarize, it took me nearly two months of phone calls between myself, the insurance company, and the provider to find out what this service would actually cost. I only avoided accidentally getting hit by a massive surprise bill because of a combination of persistence and luck.
It is nearly impossible to have any reasonable idea how much anything will cost, much less to comparison shop, when it takes months to get answers to basic questions.
Insurance billing practices should be criminal theft.
Seems like a good step. Last year had to have a medical procedure done by an oral surgeon. For some reason there are no in network oral surgeons when it comes to medical insurance. Paid a significant amount up front. Painful but thought that it was all done.
Six months later received an itemized bill for another significant amount. The worst part about it is theres no way to know if the bill is correct, or if insurance should of covered one of those line items. They really could just make up whatever they want as the system is so opaque, no one knows how much anything should cost.
Six months later received an itemized bill for another significant amount. The worst part about it is theres no way to know if the bill is correct, or if insurance should of covered one of those line items. They really could just make up whatever they want as the system is so opaque, no one knows how much anything should cost.
Universal Healthcare, free at the point of use.
I came from combo state provided, state paid healthcare system. The latter maybe ok, but never again to state provided. The service was/is horrible and health care providers are often complaining that they are angry their patients are receiving substandard care because the politicians are deciding procedure (via funding)
This doesn't solve the Taxi medallion system that physicians lobbied for to keep the supply of physicians scarce.
It doesn’t because it isn’t meant to. That’s a separate problem that can be tackled on its own merits.
Agreed
Just reliable and consistent pricing would go a long way. Right now they are doing everything they can to make the system as opaque and complex as possible. It’s an elaborate system with traps designed to extract money from the patient.
Unicorns and lollipops available on every street corner, free to all.
If every other developed nation was able to provide unicorns and lollipops to its citizens regardless of their ability to pay, and the United States couldn't I would also be asking for Universal unicorns and lollipops.
Except that the majority of the unicorns are sick, and the majority of the lollipops have been licked by someone else. And when people point out that while we don't have them on every corner for free, at least what we do have isn't like that, they're ignored or called heartless.
I would think you would need legislation to implement this rather than a regulation. The inurance-hospital-doctor lobby is rich and strong. When Colorado was considering a public insurance option, this lobby ran non-stop Fear TV commercials saying this new insurance would kill babies and seniors. (Despite seniors are on Medicare)
These regulations stem from legislation:
> Today's interim final rule with request for comments implements the first of several requirements passed with bipartisan support in title I (the "No Surprises Act") of division BB of the Consolidated Appropriations Act, 2021.
> Today's interim final rule with request for comments implements the first of several requirements passed with bipartisan support in title I (the "No Surprises Act") of division BB of the Consolidated Appropriations Act, 2021.
If it sticks, this is great! I wonder what law gives them the authority to just make a rule like this, though. I imagine the lawsuits about this issue will go for some years, as we have learned that the whole business model of some healthcare systems in this country is sticking users with these surprise bills.
If congress keeps raising the regulatory burden on insurers without actually addressing the root problem it's just going to cause prices to rise until the bottom falls out.
Maybe not bad in the long run but that must be the least efficient possible way to solve this problem.
Maybe not bad in the long run but that must be the least efficient possible way to solve this problem.
What I do: Ask the doctor/PA/nurse how much EVERY LITTLE THING they want to do costs before they do it. Sure, it's really annoying and not 100% foolproof, but it has saved me alot of money.
The entire insurance industry should just get axed.
USA is dumping twice as much money in as Canada/Europe for worst outcomes.
Warren Buffet has described our insurance system as the "tapeworm of the American economy".
USA is dumping twice as much money in as Canada/Europe for worst outcomes.
Warren Buffet has described our insurance system as the "tapeworm of the American economy".
Part of this is we also agree to spend high amounts of money for things like end of life car. Other countries simply do not spend $10M on you at end of life - period.
Well, they don't have to, because it simply doesn't cost $10M there. My understanding is that the United States medical system foremost goal is to generate profit (for shareholders?), and I think that artifically inflates the prices. Many people share the oppinion that there's no need for the medical system to make profit -- not incuring loss is enough for it being sustainable.
Its not just profit. Yes doctors and health care organizations need to make a profit. But the prices are also inflated so that those who do pay (either out-of-pocket or via insurance) cover the costs for those who don't (those with no insurance and no assets).
Is there statistics to support this? Northern europe also spends a lot of resources on end of life and other serious conditions.
My only experience is really with places like Costa Rica / some Caribbean locations. My impression was they spent a lot less on health care - and end of life care was much more modest. That said, overall health didn't seem too bad.
One thing I liked a lot - for basic health care - you could really just walk in and get near immediate service for a modest fee (doctors did not live in oceanside mansions). Prescriptions were laughably easy to get as well - antibiotics etc that in the US meant going to doctor, getting scrip, calling it into pharmacy, going to pharmacy etc - all that appears just much less regulated in some of these places. Basic imaging services / dental services also inexpensive.
They just didn't have the super advanced stuff you see in the US. So I just don't think you could spent $10M during last 12 months of life there, they don't have infrastructure / equipment to do that even if you wanted. So folks probably die earlier as a result?
One thing I liked a lot - for basic health care - you could really just walk in and get near immediate service for a modest fee (doctors did not live in oceanside mansions). Prescriptions were laughably easy to get as well - antibiotics etc that in the US meant going to doctor, getting scrip, calling it into pharmacy, going to pharmacy etc - all that appears just much less regulated in some of these places. Basic imaging services / dental services also inexpensive.
They just didn't have the super advanced stuff you see in the US. So I just don't think you could spent $10M during last 12 months of life there, they don't have infrastructure / equipment to do that even if you wanted. So folks probably die earlier as a result?
You should compare outcomes and expenses in the US with really well developed health care systems like UK, Germany, Denmark or others.
US still ranks as spending almost double (in total) per person than any of those countries. Does it have better outcomes? Better late stage life? Does it even have the same level of outcomes, with the higher price?
US still ranks as spending almost double (in total) per person than any of those countries. Does it have better outcomes? Better late stage life? Does it even have the same level of outcomes, with the higher price?
Makes you wonder how many non rich people who could start businesses and stuff are working for corporations just fir the health insurance. I think it’s many and it’s a huge drain on innovation. On the other had it keeps the little guys dependent on corporations so I guess it’s a welcome feature for the upper class.
Rates of entrepreneurship are higher in Scandinavian countries[1].
I believe that comes down to the fact that in those countries, you don't have to already be wealthy enough to afford the $36k in premiums alone each year in order to just insure a family with one kid on the individual insurance market. That $36k doesn't include the $18k+ yearly deductible, nor the co-pays or cost of care or medicine when actually utilizing the insurance.
[1] https://www.oecd.org/sdd/business-stats/EAG-2018-Highlights....
I believe that comes down to the fact that in those countries, you don't have to already be wealthy enough to afford the $36k in premiums alone each year in order to just insure a family with one kid on the individual insurance market. That $36k doesn't include the $18k+ yearly deductible, nor the co-pays or cost of care or medicine when actually utilizing the insurance.
[1] https://www.oecd.org/sdd/business-stats/EAG-2018-Highlights....
Can this be right? “ Two-thirds exit disclaimer icon of all bankruptcies filed in the United States are tied to medical expenses”
From someone living in a country (Australia)with proper government medical support, this seems insane!
From someone living in a country (Australia)with proper government medical support, this seems insane!
I find it really hard to believe that US citizens are allowing this abuse and many even defend it. Markets may even be workable if the patient actually had necessary information and hospitals, insurers and multiple middlemen couldn’t design these elaborate bureaucracies that are optimized to confuse people while extracting maximum money.
I can’t imagine any other industry getting away with this.
I wish the Democrats had had any courage to go for Medicare for all. It’s an established system that could be tweaked to expand coverage. Instead Biden will make some half assed moves which will immediately be obstructed by the republicans.
And so this travesty will keep going for many years more.
And it seems there is no hope for change.
I can’t imagine any other industry getting away with this.
I wish the Democrats had had any courage to go for Medicare for all. It’s an established system that could be tweaked to expand coverage. Instead Biden will make some half assed moves which will immediately be obstructed by the republicans.
And so this travesty will keep going for many years more.
And it seems there is no hope for change.
> I find it really hard to believe that US citizens are allowing this abuse and many even defend it.
Your average US citizen has no choice in the matter.
Your average US citizen has no choice in the matter.
>I find it really hard to believe that US citizens are allowing this abuse and many even defend it.
Because US citizens know that increasing the amount of healthcare provided will increase taxes. This whole game is being played because we want to have our cake and eat it too, with many in the middle and upper deciles betting that they will be better off without a universal healthcare type system.
>I wish the Democrats had had any courage to go for Medicare for all.
We are lucky the Democrats are even trying, and that ACA even got passed, with the compromises that had to be made. They simply do not have the numbers in Congress (and will not based on population trends) to do any more.
Because US citizens know that increasing the amount of healthcare provided will increase taxes. This whole game is being played because we want to have our cake and eat it too, with many in the middle and upper deciles betting that they will be better off without a universal healthcare type system.
>I wish the Democrats had had any courage to go for Medicare for all.
We are lucky the Democrats are even trying, and that ACA even got passed, with the compromises that had to be made. They simply do not have the numbers in Congress (and will not based on population trends) to do any more.
For me, personally, I don't mind the increase in taxes but I do mind putting more money into a broken system.
https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...
We spend more than 2x per capita than most other countries, and we don't even provide care for everyone.
Infrastructure and schools face similar issues in the US. I don't know what the answer is, but dumping more money into these systems will only make them more inefficient.
https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...
We spend more than 2x per capita than most other countries, and we don't even provide care for everyone.
Infrastructure and schools face similar issues in the US. I don't know what the answer is, but dumping more money into these systems will only make them more inefficient.
"I do mind putting more money into a broken system."
That's the problem with Obamacare. It just pumped more money into a corrupt system. The result is that premiums are going up like crazy.
For the same reason I am against cancellation of student debt. If we don't stop the increases in tuition we are just shoveling money to corrupt institutions.
That's the problem with Obamacare. It just pumped more money into a corrupt system. The result is that premiums are going up like crazy.
For the same reason I am against cancellation of student debt. If we don't stop the increases in tuition we are just shoveling money to corrupt institutions.
Premiums went up because more people started getting more healthcare.
ACA is explicitly a wealth transfer from the young to the old and from the healthy to the sick.
The young to the old because the highest premium for 64 year olds is capped at 3x the premium of 21 to 24 year olds.
The healthy to the sick because insurance companies can only charge people based on age, location, and smoking status, and cannot refuse anyone for any reason.
On top of that, healthcare cost increases slowed down after ACA. So ACA is working similar to universal taxpayer funded healthcare (which would require tax increases). It is not perfect, and it is quite likely there was a better alternative, but there were a lot of compromises that had to be made to even get ACA.
There is only one party fighting to get people healthcare, and they do not have the power on Congress anymore. And likely never will again to be able to do things with it having to heavily compromise.
ACA is explicitly a wealth transfer from the young to the old and from the healthy to the sick.
The young to the old because the highest premium for 64 year olds is capped at 3x the premium of 21 to 24 year olds.
The healthy to the sick because insurance companies can only charge people based on age, location, and smoking status, and cannot refuse anyone for any reason.
On top of that, healthcare cost increases slowed down after ACA. So ACA is working similar to universal taxpayer funded healthcare (which would require tax increases). It is not perfect, and it is quite likely there was a better alternative, but there were a lot of compromises that had to be made to even get ACA.
There is only one party fighting to get people healthcare, and they do not have the power on Congress anymore. And likely never will again to be able to do things with it having to heavily compromise.
Then they know wrongly. There are plenty of countries who already have health care systems much better than the U.S. with similar levels of taxation.
Everyone in the healthcare chain in those countries earns less than in the US. The US is going down that road, but it will not be a quick and smooth.
What evidence do you have to support this?
There-in lies the problem. You overestimate the tax increase and underestimate what you end up paying if you ever get sick.
And yes, the bigger issue is reducing hospital bills. Again, look at the line items and you'll see a big large number next to admin costs of processing insurance. Add the cost of profit for the insurance company and their cost of running the business and you know where this is going.
And yes, the bigger issue is reducing hospital bills. Again, look at the line items and you'll see a big large number next to admin costs of processing insurance. Add the cost of profit for the insurance company and their cost of running the business and you know where this is going.
Great but without legislation this probably goes away in ~3-5 years
Edit: I'm wrong, it's been legislated! Link in reply below
Edit: I'm wrong, it's been legislated! Link in reply below
This is regulation implementing legislation passed last year[1], so they should be relatively safe.
1. https://www.nytimes.com/2020/12/20/upshot/surprise-medical-b...
1. https://www.nytimes.com/2020/12/20/upshot/surprise-medical-b...
that’s 3-5 years of some people not getting absolutely crushed by medical bills… which is still a huge win. Why is the “it will change in 4 years“ argument so popular these days?
Because it makes the point that congress is completely paralyzed on most major issues, largely because of of the filibuster. They are leaving it to the executive branch and the courts to effectively write the laws. This is an enormous systemic failure, and Democrats shouldn't be high-fiving because they kicked the can down the road a little way. Why do we even have a congress if they aren't going to actually legislate?
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A lot of US policies were shaped by former Nazis. US healthcare and drug laws are just disguised eugenics. I am glad it is slowly being reversed.
My father passed away before making it home, but when all was said and done, insurance was billed $10 million in total, of which the various doctors and hospitals billed the estate $2 million. My dad didn’t have an estate because he had no assets. But imagine your life + childrens’ lives being ruined for having insurance yet filled with invisible asterisks.
At the time, NJ laws were onerous in this regard and favored insurance companies so we had no recourse. The state had a process for dealing with issues like this, but it was more of a cursory “jobs done here boss” type process and didn’t provide consumers with relief. Because of that, I moved my family out of NJ. When all contingency plans are filled with asterisks, do you really have insurance/protection?