Ask HN: Almost a thousand dollars for a 20 minute new patient visit?
47 comments
In the Bay Area:
- A 10 min visit to a specialist office, where I was seen by a nurse practitioner who was able to refer me to an exam without involving the main physician, costed $800 (just the visit, not the followup exam), which also went through deductible.
- A routine colonoscopy came at $19k with bills that kept coming for the next 6-12 months from various parties. Consumed my deductible in one shot as the first bill came.
- A visit to the ER that lasted 10 mins with an XRay costed me $5k, also sent in tranches for the next 6 months, to the point where I thought I was victim of some scam (I wasn’t). Maxed my deductible as well.
I have a couple non-critical health concerns right now I’d like to consult a doctor about, but I won’t drop another huge deductible just for that.
I am a dual citizen from a European country with a high quality healthcare public system (but admittedly longer waits than the US ). I’m not eligible for it since I’m not a resident anymore (I will when/if I move back), but as I went visiting family I booked a private appointment with a well known cardiologist and he spent a good 50 minutes with me, for a total of EUR 100.
- A 10 min visit to a specialist office, where I was seen by a nurse practitioner who was able to refer me to an exam without involving the main physician, costed $800 (just the visit, not the followup exam), which also went through deductible.
- A routine colonoscopy came at $19k with bills that kept coming for the next 6-12 months from various parties. Consumed my deductible in one shot as the first bill came.
- A visit to the ER that lasted 10 mins with an XRay costed me $5k, also sent in tranches for the next 6 months, to the point where I thought I was victim of some scam (I wasn’t). Maxed my deductible as well.
I have a couple non-critical health concerns right now I’d like to consult a doctor about, but I won’t drop another huge deductible just for that.
I am a dual citizen from a European country with a high quality healthcare public system (but admittedly longer waits than the US ). I’m not eligible for it since I’m not a resident anymore (I will when/if I move back), but as I went visiting family I booked a private appointment with a well known cardiologist and he spent a good 50 minutes with me, for a total of EUR 100.
>A routine colonoscopy came at $19k
$80-300 in capital of Poland when going full private. Its crazy than not everyone in US is combining medical/dental procedures with Euro/Asia vacation yet.
$80-300 in capital of Poland when going full private. Its crazy than not everyone in US is combining medical/dental procedures with Euro/Asia vacation yet.
Totally. $19K sounds crazy. Even if you have that money, what it’s like one or two months of salary there in SV for a well paid engineer.
You could go to Germany, Spain, France, and get a decent colonoscopy at a decent private clinic for what, less than a thousand perhaps.
You could go to Germany, Spain, France, and get a decent colonoscopy at a decent private clinic for what, less than a thousand perhaps.
Also, the quality of service is top notch. Not just the procedure execution but in private dental clinics (in Gdańsk) you lay down on a bed and there's a sizeable OLED screen at the ceiling with slow-mo clips sporting waterfalls, beaches, mountains and other "nice views" you'd expect from a deep house music clip. The background music is elevator-like though.
Don't ever accept a provider's bill or invoice at face value. Did you communicate with your insurance carrier? Their major function is to negotiate those billed charges down to something reasonable.
My provider billed $411 for the same CPT. My insurance slashed it by 50%. My copay was $40. No deductible applied, due to the plan's provision for a PCP visit.
You'll need to ensure that your insurance did their job and issued an EOB. Once the insurance has ruled on it, then you can proceed to negotiate with your provider. If the provider directly sent you a balance bill and you've not heard from your insurance carrier, then you need to reach out to insurance, not your creditors.
The creditor will also have avenues you may pursue, such as financial assistance or self-pay plans. Some may not be available due to your insurance coverage. Some people fly without a parachute and rely on the self-pay. You'd be surprised how zero-sum that can be.
Most notices demanding payment are subtly deceptive, even from legitimate creditors. I always rely on the online billing portal, or a human being who can pull up my account over the phone. Always get the latest statement. Compare all the paperwork, because timing and wording always matter a lot, especially when they're wrong!
My provider billed $411 for the same CPT. My insurance slashed it by 50%. My copay was $40. No deductible applied, due to the plan's provision for a PCP visit.
You'll need to ensure that your insurance did their job and issued an EOB. Once the insurance has ruled on it, then you can proceed to negotiate with your provider. If the provider directly sent you a balance bill and you've not heard from your insurance carrier, then you need to reach out to insurance, not your creditors.
The creditor will also have avenues you may pursue, such as financial assistance or self-pay plans. Some may not be available due to your insurance coverage. Some people fly without a parachute and rely on the self-pay. You'd be surprised how zero-sum that can be.
Most notices demanding payment are subtly deceptive, even from legitimate creditors. I always rely on the online billing portal, or a human being who can pull up my account over the phone. Always get the latest statement. Compare all the paperwork, because timing and wording always matter a lot, especially when they're wrong!
These commenters who say a service “cost” $X or they paid $Y amount: I am concerned for your negotiation skills.
I once incurred a $30,000 hospital bill while putatively uninsured. As soon as I was discharged, I went on alert for a statement. As soon as I obtained the numbers, I began to negotiate.
I contacted my prior insurance carriers. I carefully read the CFPB documents on debt collection and I downloaded their letter templates. I tracked every account and claim and payment and provider in a custom Google Sheet.
I filed for retroactive Medicaid. They determined me eligible and granted retroactive coverage through my month of hospitalization. Medicaid attempted to disavow this.
I produced the documentation sent from the Medicaid office. They gave me the wrong claims office address. I worked with claimants to correct it. The statement still reflected $30,000. I held my ground, and insisted that coverage had been obtained.
Not long after these exchanges, one day, my balance was $0.
They wiped out my entire debt.
They wrote off the whole thing.
I was absolved of responsibility.
Because I played their game and kept my purse-strings closed.
Never believe a creditor’s bill at face value. You should never pay a medical bill on receipt from a provider without checking all portals, all statements, and asking questions. Payment plans often carry no penalty and no interest. If they offer you a 60-month plan, offer them 72 months. Uninsured? Ask for “self-pay plan”. Search their website for Financial Assistance Program forms, fill out the PDF, file it with all the documentation they requested. Get busy on FAPing. Go back to the hospital, find their billing department, and burst into tears once you’re comfy in their office. Turn over bank statements, no matter how wet they got.
Your insurance carrier should always be responsible for receiving every bill, negotiating prices, and estimating how much you ultimately need to pay.
Don’t be a sucker.
I once incurred a $30,000 hospital bill while putatively uninsured. As soon as I was discharged, I went on alert for a statement. As soon as I obtained the numbers, I began to negotiate.
I contacted my prior insurance carriers. I carefully read the CFPB documents on debt collection and I downloaded their letter templates. I tracked every account and claim and payment and provider in a custom Google Sheet.
I filed for retroactive Medicaid. They determined me eligible and granted retroactive coverage through my month of hospitalization. Medicaid attempted to disavow this.
I produced the documentation sent from the Medicaid office. They gave me the wrong claims office address. I worked with claimants to correct it. The statement still reflected $30,000. I held my ground, and insisted that coverage had been obtained.
Not long after these exchanges, one day, my balance was $0.
They wiped out my entire debt.
They wrote off the whole thing.
I was absolved of responsibility.
Because I played their game and kept my purse-strings closed.
Never believe a creditor’s bill at face value. You should never pay a medical bill on receipt from a provider without checking all portals, all statements, and asking questions. Payment plans often carry no penalty and no interest. If they offer you a 60-month plan, offer them 72 months. Uninsured? Ask for “self-pay plan”. Search their website for Financial Assistance Program forms, fill out the PDF, file it with all the documentation they requested. Get busy on FAPing. Go back to the hospital, find their billing department, and burst into tears once you’re comfy in their office. Turn over bank statements, no matter how wet they got.
Your insurance carrier should always be responsible for receiving every bill, negotiating prices, and estimating how much you ultimately need to pay.
Don’t be a sucker.
That's great if you're in a position to be able to do it. When I had a major medical issue resulting in a five figure bill I had to pay out of pocket, I was busy with a long recovery and simply wasn't capable, mentally, physically or emotionally, of figuring out what of hoops to jump through and then jumping through them. It was an impossibility.
We’re approaching a crisis of caregiving in the West. Every one of us needs a loved one who is trustworthy enough, available, and willing to step in as an emergency contact, POA or proxy, in case you are incapacitated in some way.
There is a growing and aging population simply fending for themselves. Is that what A.I. is supposed to “solve”?
There is a growing and aging population simply fending for themselves. Is that what A.I. is supposed to “solve”?
It would help to have a medical system that wasn't so baroque and insane that you need to engage in herculean efforts just to survive it.
I experienced exactly the same only even more expensive: $1300! The US health care system has deeply entrenched players:care providers,insurers, hospitals, pharma industry. All make a lot of money from it. Several startups tried to tackle it. Even the combination of Amazon& Buffett &JPMorgan that set out to change it eventually caved.
https://www.cnbc.com/2021/01/04/haven-the-amazon-berkshire-j...
Hopeless case.
New primary care doctor did the same to me recently.
Made me wait 30 minutes for a 60 minute new patient appointment (based on the billing code) when the actual time with them was 10-15 minutes (and spent discussing history).
They didn’t even possess an Otoscope for looking inside the ear.
Charged >$400 and still cost me over $250.
I’ve seen other specialists that charge $100 for a visit.
Made me wait 30 minutes for a 60 minute new patient appointment (based on the billing code) when the actual time with them was 10-15 minutes (and spent discussing history).
They didn’t even possess an Otoscope for looking inside the ear.
Charged >$400 and still cost me over $250.
I’ve seen other specialists that charge $100 for a visit.
A health industry dedicated to maximizing extraction cannot possibly provide an affordable health care. Affordability nor care are amongst its purpose. Extraction is.
Providing Health services is a side effect, and one to be minimized while maximizing profit.
There is no care in the system. It is barbaric, inhumane, brutal, cruel, unforgiving.
Providing Health services is a side effect, and one to be minimized while maximizing profit.
There is no care in the system. It is barbaric, inhumane, brutal, cruel, unforgiving.
Makes you wonder how far that invisible hand goes. If extraction is the purpose, then doesn’t the incentive exist to not just keep you sick, but to make you sick?
There's the invisible foot aka bounded rationality = people act with the info they have, and often not the knowledge of delays.
People will extract all they can, and even support high prices among other extractors. They're not thinking about healing. They're thinking about their kids (who are probably doing medical school), their loans, and getting compensated for their sacrifices – the years of schooling, late nights, low initial pay.
Eventually they overextract, same with the tech bubble leading into layoffs. It doesn't take that long, but long enough for people to be blindsided by it.
People will extract all they can, and even support high prices among other extractors. They're not thinking about healing. They're thinking about their kids (who are probably doing medical school), their loans, and getting compensated for their sacrifices – the years of schooling, late nights, low initial pay.
Eventually they overextract, same with the tech bubble leading into layoffs. It doesn't take that long, but long enough for people to be blindsided by it.
Yes the system is broken - but that's how HDHP (high deductible health plan) works. Presumably your employer is contributing to your HSA, and your bill gets cheaper once you hit your "high deductible", so when you sum up everything it's slightly better than other plans.
Basically, HDHP is a yearly package deal. You choose it and accept that every year your initial hospital bill will look insane.
If your employer isn't contributing to your HSA I don't think there's any reason to choose HDHP. Or, if you (like me) don't like the feeling of doing the mental equivalent of income tax filing every time you go to hospital, HDHP isn't for you.
Disclaimer: I'm horrible with money and this comment is not financial or health advice.
Basically, HDHP is a yearly package deal. You choose it and accept that every year your initial hospital bill will look insane.
If your employer isn't contributing to your HSA I don't think there's any reason to choose HDHP. Or, if you (like me) don't like the feeling of doing the mental equivalent of income tax filing every time you go to hospital, HDHP isn't for you.
Disclaimer: I'm horrible with money and this comment is not financial or health advice.
by voting for trump, haven't americans actively decided against solidarity-based health insurance?
The US system is a special case that goes beyond partisan politics, framing it as a lack of solidarity misses the point.
The real issue is that healthcare in the US has no functioning market and no effective regulation: prices are arbitrary, patients only see costs after the fact (even if you insist cash on something simple, the itemized bill takes forever), and insurers mostly exist to extract value. Both major parties keep allowing this to exist.
In other countries (even with hybrid social systems, multi-payer, etc) there’s at least transparency and accountability. You know what you owe upfront, and regulators monitor excessive price disparities. Differentiation is allowed, but it’s still regulated.
Do you really believe UHG's 6% profit margin? US Insurance is basically private equity draining cash through inflated bills, with providers and insurers passing the buck while fleecing patients.
The real issue is that healthcare in the US has no functioning market and no effective regulation: prices are arbitrary, patients only see costs after the fact (even if you insist cash on something simple, the itemized bill takes forever), and insurers mostly exist to extract value. Both major parties keep allowing this to exist.
In other countries (even with hybrid social systems, multi-payer, etc) there’s at least transparency and accountability. You know what you owe upfront, and regulators monitor excessive price disparities. Differentiation is allowed, but it’s still regulated.
Do you really believe UHG's 6% profit margin? US Insurance is basically private equity draining cash through inflated bills, with providers and insurers passing the buck while fleecing patients.
> The US system is a special case that goes beyond partisan politics, framing it as a lack of solidarity misses the point.
The last time someone tried to improve things he was Adolf Stalin for trying to recreate Nazi Communist Germany. Or something. Something similar (albeit less extreme) happened in the 90s.
Fixing any of this does start with politics and there is a huge political elephant standing in the way here. It's really not a "both sides" issue when one side uses every bad faith trick in the book to obstruct anything the other side does while proposing nothing of their own.
The last time someone tried to improve things he was Adolf Stalin for trying to recreate Nazi Communist Germany. Or something. Something similar (albeit less extreme) happened in the 90s.
Fixing any of this does start with politics and there is a huge political elephant standing in the way here. It's really not a "both sides" issue when one side uses every bad faith trick in the book to obstruct anything the other side does while proposing nothing of their own.
I surmise that you are referring to "universal healthcare". The President does not get to choose a model of healthcare for the nation, so no, my vote was not cast against whatever you're talking about.
Here are a few aspects of the Affordable Care Act:
- In the before times, health insurance was strongly tied to American employers. Their group purchasing power made it affordable, and it is counted in the benefits package. A quitting employee, or a firing employer, would have the understanding that, barring COBRA and other mitigations, the separated employee would lose their group insurance benefit.
- Many hospital systems have offered financial assistance, and self-pay plans, to uninsured patients. Qualify for Medicaid/Medicare, or avail yourself of one of these plans.
- The Affordable Care Act is a tax on the uninsured. Purchase insurance with the tax, or pay the tax directly. "Uninsured" is now the worst situation to be in, financially.
- The ACA signaled to employers, "fire at will." If an employee needs to be fired then they can scoop up insurance on the marketplace. The employer no longer needs to worry about the separated employee's well-being.
- Meanwhile, the employees have received the message "quit all you want." If you can live without the salary then you can scoop up an ACA plan on the Marketplace. Your risk of crippling medical debt is thereby somewhat mitigated.
- Various groups have been setting up Health Sharing plans which affirm that the Health Insurance model is irreparably broken. A Christian Health Sharing Ministry is a mutual-aid fund where members pool their funds and then expenses are paid according to their needs, per the Book of Acts, and mostly conforming to quasi-insurance regulations.
We're all limping towards Universal Healthcare and Single-Payer Insurance. That's the eventual end-game for most pundits. It may go back and forth for a while. But nobody can deny that we're aiming to replicate models in the UK and Canada.
Here are a few aspects of the Affordable Care Act:
- In the before times, health insurance was strongly tied to American employers. Their group purchasing power made it affordable, and it is counted in the benefits package. A quitting employee, or a firing employer, would have the understanding that, barring COBRA and other mitigations, the separated employee would lose their group insurance benefit.
- Many hospital systems have offered financial assistance, and self-pay plans, to uninsured patients. Qualify for Medicaid/Medicare, or avail yourself of one of these plans.
- The Affordable Care Act is a tax on the uninsured. Purchase insurance with the tax, or pay the tax directly. "Uninsured" is now the worst situation to be in, financially.
- The ACA signaled to employers, "fire at will." If an employee needs to be fired then they can scoop up insurance on the marketplace. The employer no longer needs to worry about the separated employee's well-being.
- Meanwhile, the employees have received the message "quit all you want." If you can live without the salary then you can scoop up an ACA plan on the Marketplace. Your risk of crippling medical debt is thereby somewhat mitigated.
- Various groups have been setting up Health Sharing plans which affirm that the Health Insurance model is irreparably broken. A Christian Health Sharing Ministry is a mutual-aid fund where members pool their funds and then expenses are paid according to their needs, per the Book of Acts, and mostly conforming to quasi-insurance regulations.
We're all limping towards Universal Healthcare and Single-Payer Insurance. That's the eventual end-game for most pundits. It may go back and forth for a while. But nobody can deny that we're aiming to replicate models in the UK and Canada.
Can't speak for your location specifically, but some places in the US have cash only doctors charging low fees for routine/easy visits. Some urgent cares offer primary care similar to that too. My guess is it will still be more expensive where you are due to cost of living. Most insurers have cost estimator tools on their website that help you price compare providers, so that might be an option for you.
I can't believe so many people on HN think that healthcare in the US is under the free market. Lol.
For starter, can you cure a person if you're not part of the AMA cartel? You can't, the State will ruin you.
Can you open an hospital without being allowed by other hospitals, your competition? In many States you can't.
If you find and innovative way to organize labor, can you test it? Nope.
Just the first few things that come to mind.
Healthcare in the US is much less free market than in European countries like Italy, and these are the results.
But it's amazing that people on HN din't see it, what happened to this place?
Healthcare in the US is much less free market than in European countries like Italy, and these are the results.
But it's amazing that people on HN din't see it, what happened to this place?
most things have two codes. dr visit. dr visit extra expensive. blood work blood work extra expensive.
i kid you not. everyone in health care knows this. and a patient have no way of knowing.
if it goes to your plan, they just pay the cheap code and the provider doesn't even say anything. if it's on your copay only, the plan will not help you and will laugh at your face. and it's all legal.
i kid you not. everyone in health care knows this. and a patient have no way of knowing.
if it goes to your plan, they just pay the cheap code and the provider doesn't even say anything. if it's on your copay only, the plan will not help you and will laugh at your face. and it's all legal.
The scalable way forward is to vote, and to get your friends and family to vote. Not just national, but local elections.
> This feels absurd. I get that healthcare is broken, especially in tech-heavy cities like SF, but $867 for a routine visit is hard to justify.
Welcome to the biggest GDP in the world. Your contribution is what makes the US GDP so big :)) this would be free in many places but who would want to live in a poorer country?
> Is anyone working on viable alternatives? Concierge models? Subscription care? Could this be a startup opportunity or is regulation the only fix?
What created the problem was multiple generations of entrepreneurs "trying to fix it" for their own profit. More of this will only make it worse.
Welcome to the biggest GDP in the world. Your contribution is what makes the US GDP so big :)) this would be free in many places but who would want to live in a poorer country?
> Is anyone working on viable alternatives? Concierge models? Subscription care? Could this be a startup opportunity or is regulation the only fix?
What created the problem was multiple generations of entrepreneurs "trying to fix it" for their own profit. More of this will only make it worse.
As a Doctor in Europe I can imagine the US is a haven as a professional but hell as a patient. I have no idea how this can be changed without disrupting a huge proportion of the economy and people that is based on this exploitation. It can start from anything, from black market out of pocket to civil unrest and revolution.
From 2003–2018, I developed a close relationship with a PCP, even though he moved 4 times, joined a new medical group, substituted a PA to do his dirty work, and my insurance carrier took evasive action. That PCP was ultimately subsumed into the Veterans Administration; needless to say, I could not follow him there.
More than one GP has griped to me about a crushing workload with a daily roster of patients who have neglected/abused their bodies for decades and are incapable of following advice/orders. (Like me)
A constant stream of pharma sales droids treat prescribers to lunch. There’s a website where you can track their “gifts” to specific providers. Or, just rent “Love & Other Drugs” which is disguised as fiction.
Remember when the national motto was “flatten the curve” because we wouldn’t want to flood hospital beds with COVID patients? They were actually more concerned about dramatically poor staffing levels across the board. Hospitals can’t open any beds without nurses.
Insurance customers have reported being placed in “ghost networks”. These are impressive and extensive networks of specialists who no longer exist, moved out of state, or network contract has lapsed 8 years ago. Even with Medicaid, you’ll need to query 3 databases to eliminate the stale entries.
The main hospital system in my city (Steward) filed for bankruptcy last year. All the equipment broke, including HVAC, in their BH inpatient facility, so it shut down. A new owner has taped their logo over the Steward signs.
There aren’t enough MD or DO slots in the pipeline, so the industry churns out a smorgasbord of NP, PA, MA, and other quasi-practitioners to fill the gaps, bewildering patients and usurping focus from the actual physicians.
Other than that, American physicians are floating on Cloud 9 — thanks for asking!
More than one GP has griped to me about a crushing workload with a daily roster of patients who have neglected/abused their bodies for decades and are incapable of following advice/orders. (Like me)
A constant stream of pharma sales droids treat prescribers to lunch. There’s a website where you can track their “gifts” to specific providers. Or, just rent “Love & Other Drugs” which is disguised as fiction.
Remember when the national motto was “flatten the curve” because we wouldn’t want to flood hospital beds with COVID patients? They were actually more concerned about dramatically poor staffing levels across the board. Hospitals can’t open any beds without nurses.
Insurance customers have reported being placed in “ghost networks”. These are impressive and extensive networks of specialists who no longer exist, moved out of state, or network contract has lapsed 8 years ago. Even with Medicaid, you’ll need to query 3 databases to eliminate the stale entries.
The main hospital system in my city (Steward) filed for bankruptcy last year. All the equipment broke, including HVAC, in their BH inpatient facility, so it shut down. A new owner has taped their logo over the Steward signs.
There aren’t enough MD or DO slots in the pipeline, so the industry churns out a smorgasbord of NP, PA, MA, and other quasi-practitioners to fill the gaps, bewildering patients and usurping focus from the actual physicians.
Other than that, American physicians are floating on Cloud 9 — thanks for asking!
I don't think they get the full amount as a doctor, maybe not even close. I didn't see/find any independent practice in the US, it's mostly large clinics and the doctor is kind of attached to the clinic or something like that.
> I can imagine the US is a haven as a professional but hell as a patient.
Every doctor I've talked with has told me that the US medical system is hell as a doctor, too.
Every doctor I've talked with has told me that the US medical system is hell as a doctor, too.
The space is clearly ripe for disruption, but unfortunately it'll never happen.
Problem 1 is that most of the electorate are healthy, and sickness is transitory, so it's not a "single issue" topic like say guns or abortion.
Problem 2 is that elections cost money. Lots of which is provided by industry, in this case the health care industry.
Problem 3 is that the political climate is such that partly politics requires disagreement. If Democrats are pro universal Healthcare then Republicans have to be against it. Even if the public are very much in favor of something, it's preferable to not do it, but rather just fight about it.
In short the system is clearly bonkers, but there's no political will in the electorate, and certainly not in politicians to change it.
Of course, capitalism doesn't see this as broken at all. The system, both democracy, and the "free market" are working perfectly. Only the customers are suffering and they are not enough to overcome the entrenchment.
Problem 1 is that most of the electorate are healthy, and sickness is transitory, so it's not a "single issue" topic like say guns or abortion.
Problem 2 is that elections cost money. Lots of which is provided by industry, in this case the health care industry.
Problem 3 is that the political climate is such that partly politics requires disagreement. If Democrats are pro universal Healthcare then Republicans have to be against it. Even if the public are very much in favor of something, it's preferable to not do it, but rather just fight about it.
In short the system is clearly bonkers, but there's no political will in the electorate, and certainly not in politicians to change it.
Of course, capitalism doesn't see this as broken at all. The system, both democracy, and the "free market" are working perfectly. Only the customers are suffering and they are not enough to overcome the entrenchment.
"Is anyone working on viable alternatives?"
Have you tried calling your local representative?
Have you tried calling your local representative?
Locals unsurprisingly ignore grave incentivelessness.
At the end of the day, much like housing cannot be both affordable and a good investment, healthcare cannot be both affordable and a lucrative career. Avoid going to an MD if you can get the same care from someone else.
So nothing can be done to fix the problem?
You could get healthcare from someone who doesn't have to go $100ks in debt first, and then expects to make more than you do. If no such person with that profile exists, then yeah you're stuck paying the rate of the system that trained and employs them.
How do health insurance company employees go into 100s of thousands in debt?
You know that the issue is not the salaries of doctors, right? Or the salaries of nurses.
Why are you making such an obvious bad faith argument in public?
You know that the issue is not the salaries of doctors, right? Or the salaries of nurses.
Why are you making such an obvious bad faith argument in public?
Specific to the Bay Area, you could travel out a ways see a practitioner that isn't overbooked.
The uninsured pay the highest rates.
And because poor paying jobs tend to lack health insurance (and all gig economy work does), healthcare is a primary cause of personal bankruptcy.
I mean $867 is more than three weeks full time gross at the Federal minimum wage…but most minimum wage jobs don’t offer full time and the working poor have payroll taxes.
Concierge models? Subscription care?
These are premium products for people who can afford premium service.
Could this be a startup opportunity
No. Venture capital seeks above market rate returns. What you describe is below market rate. Or to put it another way, capitalism can’t fix capitalism because capitalism assumes capitalism is not broken.
whether there's a scalable path forward
Don’t get sick is one option.
Work for an employer offering good health coverage is another.
Be wealthy is the third.
Change your phone number to avoid collections is a fourth.
Or pay the bill if you are lucky enough to have that kind of money…and be glad its not your child and the condition is not serious. Good luck.
And because poor paying jobs tend to lack health insurance (and all gig economy work does), healthcare is a primary cause of personal bankruptcy.
I mean $867 is more than three weeks full time gross at the Federal minimum wage…but most minimum wage jobs don’t offer full time and the working poor have payroll taxes.
Concierge models? Subscription care?
These are premium products for people who can afford premium service.
Could this be a startup opportunity
No. Venture capital seeks above market rate returns. What you describe is below market rate. Or to put it another way, capitalism can’t fix capitalism because capitalism assumes capitalism is not broken.
whether there's a scalable path forward
Don’t get sick is one option.
Work for an employer offering good health coverage is another.
Be wealthy is the third.
Change your phone number to avoid collections is a fourth.
Or pay the bill if you are lucky enough to have that kind of money…and be glad its not your child and the condition is not serious. Good luck.
yeah it's bullshit
go to ChatGPT and ask it to ask you relevant questions w.r.t. what blood tests you should order. then book them at Quest Diagnostics yourself for like $100 total. then ask it how to interpret the results.
voice any other concerns you might have as well.
follow up with human doctor only if necessary.
go to ChatGPT and ask it to ask you relevant questions w.r.t. what blood tests you should order. then book them at Quest Diagnostics yourself for like $100 total. then ask it how to interpret the results.
voice any other concerns you might have as well.
follow up with human doctor only if necessary.
Is this a joke? Or would you really trust your health to an LLM?
I took my kid to an ER with an emergency medical issue and the three specialists had no fucking idea what to do and were going to plan a treatment that wouldn't have helped while he died. Meanwhile we asked ChatGPT while we were beside him in bed, feeling doomed about the ventilator they were preparing for him what it could be and it identified the actual thing that was killing him and we pointed it out to them and they stopped
everything and treated him for that thing instead and he was released the next morning and fully recovered.
The median doctor is probably worse than an LLM at this point.
The median doctor is probably worse than an LLM at this point.
Not the original poster but seems like some people see the use of LLMs as a cool factor, a cheat code providing them with information or ideas unavailable elsewhere.
In some ways they are right, the hallucinated drivel / slop unrealated to reality is unique. I guess.
And for people who cannot tell the difference, the slop synthesized to please them, well, pleases.
In some ways they are right, the hallucinated drivel / slop unrealated to reality is unique. I guess.
And for people who cannot tell the difference, the slop synthesized to please them, well, pleases.
an LLM saved my little boy's life actually
https://news.ycombinator.com/item?id=44085356
https://news.ycombinator.com/item?id=44085356
Yes it’s broken. The solution is and has always been a comprehensive single-payer system combined with price controls.
Roosevelt tried to do it almost a century ago in 1935, but the moron greedy traitor racist fascist conservatives blocked it.
Roosevelt tried to do it almost a century ago in 1935, but the moron greedy traitor racist fascist conservatives blocked it.
This is effectively what function health is trying to solve -> https://my.functionhealth.com/signup?code=JELSISI10&_saasqua...
That is not what function is trying to solve. Function is selling a semi annual blood testing for $500/yr for screening purposes.
I think this replaces the need for something like an $800 annual check up. I've asked my doctor for a comprehensive blood panel and they're only willing to give ~30$ worth of blood tests, maybe 2 pages of results. You don't end up learning enough to solve your actual health needs.
Many blood tests don't even need a script and you can get them directly through places like Quest or Lab Corp. A few blood tests should not replace an annual checkup as they cover almost completely separate things. An annual checkup should not cost you $800 in most localities. I believe the ACA even includes 1 covered preventative visit per year. What are your health needs? You don't need a $500 battery of random tests. If you have a problem you can work with a provider to order the targeted tests and scans.
I booked a new-patient visit with a UCSF physician. The appointment lasted about 20 minutes. A few weeks later, I got the bill: $867. I assumed it was a mistake, but after calling, I learned this was the correct charge for CPT code 99204 (new patient visit, 45–59 minutes). Insurance won’t cover it due to my deductible.
This feels absurd. I get that healthcare is broken, especially in tech-heavy cities like SF, but $867 for a routine visit is hard to justify.
Is anyone working on viable alternatives? Concierge models? Subscription care? Could this be a startup opportunity or is regulation the only fix? Curious how others are navigating this and whether there's a scalable path forward.