I just had some bloodwork done, myself. My provider accidentally billed insurance, which had lapsed due to being laid off. I got my "Explanation of benefits" and it was $1000 billed to them, but I was given a $500 "discount." So I only owed $500... Cash cost was $50. Makes no goddamn sense.
Also I went in for a colonoscopy and an endoscopy. Insurance was billed for $14000. I got statements from 4 different doctors, and the facility where it was performed. None of the statements matched the explanation of benefits from the insurance company. And when I called each doctor, to pay them, they all told me that I didn't actually have to pay them what it said I owed. So I just ended up paying $2500 to the insurance company. It again, makes zero sense.
It makes perfect sense. The prices are inflated with a few extra zeroes to try to force people to get any job with insurance. The big numbers are just to scare people. You can also turn negotiating with the hospital into a full time job and get the real numbers. If you're too unhealthy to do either of these then you can just die I guess.
Well, there is that. But there is also the fact that they charge you or your insurance company to smooth out other costs like $2,000,000.00 cancer treatment or for people who show up to the hospital, don’t have insurance, and the hospital has to treat them.
I’m reaching the point where I don’t really care if it’s private or public, but what we are doing today is the worst of both worlds. It either needs to be fully private, maybe with mandatory insurance purchase, or it needs to be fully public, though that has its own baggage.
“ But there is also the fact that they charge you or your insurance company to smooth out other costs like $2,000,000.00 cancer treatment or for people who show up to the hospital, don’t have insurance, and the hospital has to treat them”
I bet whatever cost these patients cause, the hospital will inflate this by an order of magnitude. It’s the same with charity care. Hey, my sticker price for an aspirin is $1000. I’ll give away 10 aspirin and I can get credit for $10000 charity.
A lot of that is tied into billing in general, even without the people who can't afford to pay for their care. When they send out an invoice for $50,000 for services rendered, even if the insurance company only ends up paying them a fraction of that, when it comes to accounting and taxes you can be sure they are using that $50,000 number for deductions and such when it benefits them.
This uncertainty of what things cost would kill me. It must be terrible!
We had a baby 2 weeks ago, which included 4 nights in the hospital before and after the birth, a surprise c-section, various specialists, follow ups, consultants and blood tests.
Our total outlay so far is about €30 for the parking at the hospital every day.
We have insurance, but we did not use it for the baby. I need to see a dermatologist next week. Cost will be €300, which I can claim back from my insurance afterwards. I just punch the doctor's name into my insurance portal, and they list the procedures and the amounts I'm covered for each.
If I asked my GP to refer me to a public dermatologist, I would have waited longer for an appt, but I would have only had to worry about parking at the hospital, everything else would be free.
>> I don't think the hospital expects to actually ever get paid what they bill out
OH YES THEY ABSOLUTELY DO!
When I was in-between jobs I had a medical emergency and I was on the ACA around the first year it was offered. I was billed above medicare rates so I was on the hook for ~40k after out of pocket max. They told me this limit is what insurance has to cover but hospitals can still bill above it. First they told me they could work on the prices and asked for my last 5 years tax returns. When they saw that I had dividend payments they said they couldn't help me and I owed them the $40k. I think that was the problem because even though I wasn't working in their mind if I had investments then technically I was not in need so they set up four-year payment plan and paid every penny with no cost reduction.
I probably did something wrong but to this day I didn't know what I would have done differently. The only people I could talk to were the hospital and they only cared about the hospital.
This happened in 2013, 9 years before the Act. Hopefully the Act prevents this kind of stuff. The medicare limit is what really confused me. If there is a limit insurance will cover up to, then how is it possible to exceed that limit?
I really don't believe you, but according to HN, I am supposed to trust in good faith you aren't lying.
Maybe you just don't have any assets or make very little money. I have equity and cannot just toss it to a collection agency and hope they forget. I also play by the rules, silly, I know, but I don't want to risk getting fucked some other way later in life.
In practice, the whole system is set up in a way that discourages asking questions. Waste of time. It's truly the opposite of the transparent ideal market.
That’s what is insane. I called my insurance to ask if some tests were covered since preventative care is 100% covered.
They couldn’t answer if cholesterol test would count. How is that not automatically classified as preventative? It’s one of the most basic metrics.
So they want me to get the doctor to give me the ICD code and the diagnosis code. Or something. Two different codes. They’ve added so much bureaucracy and crap into the system because they can. Nobody’s stopping them and there’s too many fingers in the pie.
I think you might be confused by the terminology. Under the ACA (Obamacare) there are a limited set of preventive health services that are covered at no cost to the patient. These are a subset of all preventive care services that meet strict criteria for effectiveness. Cholesterol screening may or may not be included based on your age and diagnosed conditions.
> How is that not automatically classified as preventative? It’s one of the most basic metrics.
They're incentivized to classify whatever they can as not being their problem, so it makes sense for them to double-check everything - there is always a possibility that some edge case was found that lets them off the hook for some specific test or treatment. Moreover, obscuring information and spreading support staff as thinly as possible means that extra barriers heavily discourage people from fully knowing what they'll be on the hook for, which makes them more likely to just nod their heads and do/pay what is asked. These decisions aren't driven by medical concerns. It's a universal problem of nearly all kinds of privatized insurance - their core incentive is to ask for as much money as possible and provide as little in return as it's legally feasible. All the things mentioned in this comment thread are used to thwart any possibility of competition, which would otherwise act against this strong pull towards pure profit-seeking.
The place where I live is often used by Americans as the first line of defense to justify their healthcare system. Among certain political circles, there is almost a reflex to point at us and say "see how terrible it is?!" by exaggerating all the drawbacks and minimizing all the upsides. Yet even in such a flawed, underfunded, mismanaged system, my government insurance plan covers all "medically necessary" lab testing, with a couple rare exceptions that are only covered if you're diagnosed with certain conditions. The process of getting a test consists of a doctor filling out a standardized sheet, then going to a lab and handing them that sheet and my regional insurance card. No money exchanged.
It took me two weeks, dozens of phone calls, and multiple "escalations" to learn what would be covered and what the price would be if it wasn't
Totally insane. The kicker is that after all that, the price I was billed wasn't even the price I was given (thankfully it was less though).