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by 1letterunixname 1161 days ago
That's a shitty bill. It's also insane that US doctors and hospitals aren't required to post prices, keep prices reasonably within an allowed range, and are allowed to price gouge customers for however much they want without limit.

In Redding CA, I ran across a woman with a nasal infusion pump tube taped to her face in a coffee shop. She was hurriedly collecting paperwork for a hearing across the street. It turns out she was preparing to go through bankruptcy proceedings while she was dying from incurable Stage IV cancer. That the doctors and hospitals were vultures picking her life apart for money while she was dying but still alive and making her end-of-life as miserable as possible was adding insult to injury. Some hippocratic oath. More like hypocritical chisels out to monetize misery.

So when someone is out of money and dying in America, they are treated like criminals with court proceedings. At their hearing, they get a chance to justify their existence requires clothes, transportation, and housing while everything else goes to creditors.

8 comments

My mother got cancer (she survived it, fortunately). She had a fantastic insurance policy, made good money (well above the average income), and had money in the bank.

Her medical costs ended up bankrupting her. That was where the scales fell from my eyes and I learned that what we're taught about the purpose of insurance (to protect us in the case of a catastrophic expense) is just pure BS.

Was this before or after the ACA? As far as I understand it, the ACA got rid of ceilings on benefits and added a max pay per year.
Much before. But what did her in wasn't benefit ceilings, but rather the insurance company fighting everything they were obligated to pay out. it wore her down. It's very hard to fight the insurance company while at the same time fighting cancer. She got down to 80 pounds, couldn't eat, sleep, or do much of anything more than just hang in there. Constantly engaging in dispute resolution with the insurance company was not something she was capable of.

And they knew it. That's why they fought paying out every nickel. Evil bastards.

If it doesn't show, I have literally nothing good to say about the insurance industry.

Ok, I'm just wondering, because I think the law would firmly be on her side if it happened after the ACA was passed (they can no longer call policies with benefit ceilings as health insurance, you have an out of pocket maximum that is pretty hard set in stone...the dispute would just be in if something was covered at all or not). That still leaves plenty of things wrong with our system, of course.
Are there by chance companies you could pay to do this on your behalf as a service? (get the money owed by insurance) Seems like something ChatGPT would be good at, if this doesn’t already exist, and then the company would charge a small percentage of what they force the insurance company to pay. If ChatGPT can ace the bar exam, you’d think it could devour all the related case law and coverage legalese from your policy, and generate effective legal responses.
I assume you're using the word "fantastic" as in "imaginative or fanciful; remote from reality"?
I mean it as in "much better than average", of course.
I got charged $5000 for a 30-minute preventative echocardiogram (basically an ultrasound) that insurance was supposed to pay 100%.

20 emails later it's now at debt collectors, and I've contested the debt twice.

I'm ready to appear in court if I have to. I'm ready to pay $8K in lawyer fees to get rid of this $5K bill because it's wrong. I just don't want this to impact my credit score because it's not my debt.

I hate you, Stanford Healthcare.

Why didn't the insurer pay? Was it not covered? And what setting was it in, outpatient or ER? If ER then you should be able to dispute with your insurer to get it covered. If outpatient you might be able to negotiate with the Financial Services folks that they (the doctor) did not submit for pre-authorization appropriately per industry standards.

That's where you build your argument that they acted inappropriately and did not disclose prices (did they?). The next question is are you on a State plan or a corporate EIRSA plan? If State they you can file a complaint with the California department of insurance. If you have a corporate plan, which is likely self funded, then I would ask your HR to talk to your insurance rep. You might find things get retroactively covered at that point. Or you can talk to the news. They love to report on these things.

Stanford has pattern of inflated charges. Hearing tests in audiology for example are ridiculously overpriced without insurance and they don't pre-authorize. And most insurers don't cover hearing tests anyway. Stanford could fix this by not being greedy.

> Why didn't the insurer pay? Was it not covered? And what setting was it in, outpatient or ER?

Outpatient. Routine preventative care, I have a heart condition so echocardiograms are done every 2-3 years as a preventative measure. Insurance plan claims 100% coverage of preventative care with no deductible or coinsurance. I tried to dispute with insurance but they insist that it wasn't preventative (it's my body, my health, I know better than them that it was preventative) and they consistently would put me on hold for VERY long times on the phone until 5pm and then say "whoops, we're closed"

> The next question is are you on a State plan or a corporate EIRSA plan?

Self-purchased out of marketplace plan (HealthNet). I was self-employed at the time.

> Or you can talk to the news. They love to report on these things.

I would absolutely love if someone can put me in touch with a contact.

Look into https://www.dmhc.ca.gov/fileacomplaint.aspx

I imagine an expert from the DMHC can advise on your specific situation.

Oh my word.

2018, I was on Medi-Cal (Medic-aid) and had a stress ECG, right heart catheterization, and 12-lead EKG when admitted to their cardiac unit for 3 days. Cost $0.

Like a third-world country: in America, you're better off being either totally penniless or a billionaire. If you don't have a balance sheet of $5 megabucks, your life will be miserable.

The advantage most European and other countries have under socialism is it means there's a minimum average quality of life everyone. Pay more in taxes but get a lot more in terms of a more dignified, healthier, and longer life free from the slavery of "gotcha!" gangster capitalism.

> Like a third-world country: in America, you're better off being either totally penniless or a billionaire. If you don't have a balance sheet of $5 megabucks, your life will be miserable.

I live in a "third-world" country. My family and I have insurance and only use private hospitals -- the capitalist portion of the system. Never had as bad an incident as the ones you guys are reporting here. Just some minor annoyances.

Not even the crappiest insurance companies do stuff like that, and they get terminated by the regulatory body if they start to mess up consistently.

Although I don't use it directly, I'm overall well-informed about the realities of the public health system. It's bad, but not even close to what I've seen posted here. One can even obtain overly expensive meds for rare diseases -- it requires some legal effort, but it eventually works.

Then I'd say that, when it comes to health systems, the USA is definitely way worse than some third-world countries -- and one of the main reasons I declined an invitation to work and live in there.

When I was living in China working for Microsoft, our company provided insurance had a cap on claims paid ($100k), so while everything was cheap enough via the private system, I wondered if I was screwed if I ever got cancer or something really bad.
Yeah that doesn't sound like insurance to me at all.
It used to be common here in the US too, to have a cap on the amount an insurance policy would pay out.

My first “adult”/non-parental healthcare insurance policy had a yearly maximum and a lifetime maximum. This was pre-Affordable Care Act.

> The advantage most European and other countries have under socialism is it means there's a minimum average quality of life everyone. Pay more in taxes but get a lot more in terms of a more dignified, healthier, and longer life free from the slavery of "gotcha!" gangster capitalism.

It will sound like a nitpick but it's not: there's no socialism in Europe. Socialism is an economic system, not a synonym for "socially-focused policies" through societal-level welfare.

European countries are capitalists, completely. What we do have is a better support system for welfare, more labour protections and regulations to protect against the massive power imbalance that untamed capitalism creates but it's not socialism. Not even close.

> It will sound like a nitpick but it's not: there's no socialism in Europe.

If Europe has no socialism they've still somehow managed to end up with a lot of European Socialists (https://en.wikipedia.org/wiki/Party_of_European_Socialists). Some words are basically meaningless because everybody has their own definition for them and socialism is certainly one of those words. It's probably better to avoid the term entirely and just describe what you mean because some people get so emotional just hearing it that they seem to lose the ability to think.

Words have meaning, socialism has a meaning:

> Socialism: a political philosophy and movement encompassing a wide range of economic and social systems, which are characterised by social ownership of the means of production, as opposed to private ownership.

That is the meaning, it's not meaningless. It becomes meaningless when people just accept that it can mean anything they want, it can't. Socialism has a very specific characteristic: social ownership of the means of production.

If people misuse the term they need to be corrected. At least until the meaning completely shifts to something else, like what Americans try to do with the term "liberal" which does not, at all, mean "progressive" as is the usage in the USA.

Words do have meanings, the word socialism has so many meanings that using the term just makes things less clear. Even your preferred definition is so overbroad that it strains usefulness. Any definition that lumps together the political philosophy of Keir Starmer with that of Joseph Stalin is one of questionable utility.
Doctors are NOT to blame here. It's almost as inscrutable and impossible for them to understand the process as the patients. Doctors often times have to battle insurance companies on behalf of the patients to get them the drugs they need with coverage. My wife is a cancer physician and spends hours on the phone convincing insurance companies that patients actually need the treatments she's proscribed. It's an infuriating waste of time.

She also has little to no visibility into cost incurred by the patient, and often times there isn't a menu of options to pick from. She's not incentivized to perform extra testing/etc, and keeps patients costs in mind while providing care. I don't think that's rare among doctors. The whole system is frustrating, but yes mostly so for the patient.

Doctors could, to some approximation anyway, go on strike. They endorse the system we have by working in it (and have not been silent participants in building either).
It seems uncommon for one group to strike on behalf of another group. Pragmatically that seems very unlikely to happen even if theoretically possible. Policy level changes seem more likely to me.
That is by design. Look up the Taft-Hartley Act. Secondary striking is a forbidden labor practice in the United States. Any doctor's union that orchestrated one would be in hot water legally. It would essentially have to be a collective action orchestrated by distinct individuals with no legal entity providing any type of war chest.

To be clear, I believe at least that section of Taft-Hartley is arguably unconstitutional, and worthy of getting civil disobedienced hard. I just don't see it as likely to happen in such a way as to be effective in facilitating change. Add on top of that the onerous burden of medical school debt, and I don't exactly see many being willing to make that choice.

Okay, but the point is sort of that doctors are not in fact blameless for the system that they helped build and continue to participate in.

Like sure, they aren't solely to blame, and it would probably be hard for individual doctors to successfully push for systematic changes, but the flip side to that is that they don't get to say "Oopsie doopsie, it sure isn't great".

I disagree. Doctors did not build the insurance billing system that we have today, and are not implicated in creating the incredible complexity and challenge that exists for patients. They provide the care, and don't get to view the costs born by patients.
That particular deck is stacked against the favor of doctors and patients.

After all, a care facility can probably be reasonably confident that if a patient needs help, doctors will feel compelled to care for them.

Put another way, would you want to walk into a hospital/ER/your doctors office for something acute and get an apology that care is unavailable because the doctors are on strike?

I imagine he’s suggesting a strike where they do not fill out the necessary billing paperwork, like Japanese bus drivers didn’t collect fares or the Canadian customs officers didn’t collect tariffs during their strikes. Not sure if that’s possible, but that’s how I’d think they can strike.
This would absolutely work when the EHR/EMR is down. Otherwise, most of that stuff is automated and pulled directly from the medical/surgical records in the EHR/EMR.
Providers are a full half of the problem! We live in a market economy, and it is doctors' responsibility to be able to answer straightforward questions about how much various treatments will cost, just as every other profession gives quotes and estimates. Pretending that money doesn't exist is doing a grave disservice to patients, for whom money most certainly is a concern.

In the short term, I know it's a tall ask for a provider to be able to tell a patient how much care from other providers might cost. But providers could certainly start by knowing the prices of services that they themselves perform. And if that's too hard because their billing departments have made it opaque with a whole slew of prices depending on who might be paying, then providers need to work on reforming their own houses before pointing fingers at the other half of the problem.

Hospital administrators don't take a hippocratic oath, unless they happened to also be doctors too.
Most were. Still, their staff do. But the point you're appearing to make normalizes injustice if they didn't happen to take an oath. What does this have to do with anything?
The vast majority of hospital admin staff aren't. Plenty of secretaries, orderlies, cafeteria workers, and janitors. The accountants, IT, lawyers, and HR probably weren't doctors or nurses either.
Only pointing out that many didn't take an oath, not that what they're doing is ethical. Holding people to an oath they didn't take doesn't make much sense.
Hospitals have been required to post price lists for several years.

https://www.cms.gov/hospital-price-transparency

This won't be effective unless the hospital is required to provide prices whenever people ask, such as requesting an estimate from your car mechanic. And not only providing the prices but being required to honor the price they give you, with some reasonable threshold of variance.

These hospitals posting their prices reminds me of this classic section of "The Hitchhikers Guide to the Galaxy":

"But the plans were on display..."

"On display? I eventually had to go down to the cellar to find them."

"That’s the display department."

"With a flashlight."

"Ah, well, the lights had probably gone."

"So had the stairs."

"But look, you found the notice, didn’t you?"

"Yes," said Arthur, "yes I did. It was on display in the bottom of a locked filing cabinet stuck in a disused lavatory with a sign on the door saying 'Beware of the Leopard.'

Due to the No Surprises Act, healthcare providers are now legally required to give patients a good faith cost estimate in certain circumstances.

https://www.cms.gov/nosurprises/consumers/understanding-cost...

https://www.cms.gov/nosurprises

It's meaningless unless you can get a price before you get services.

The trouble is even if the price list says $500 for something, they'll charge you $8000 for "general classification" and $2000 for a Tylenol.

I have a remote heart monitor at my bedside that, upon pressing a button, wirelessly retrieves data about arrythmia incidents from my implanted defibrillator and sends any incidents to the hospital. Every time I hit the button, even if there are ZERO incidents for them to review, I get hit with a $300 bill for some "general classification". So I hit the button less often than I'm supposed to.

Exactly.

Come in unconscious and bleeding out from a car wreck: "No, no, no.. take me to the other hospital with lower prices. And I don't want $100 acetaminophen."

Not all hospital visits are emergencies. I had an implanted defibrillator replaced recently. It's a life-saving device but I had a 3-month window to do it, so I most definitely picked "the other hospital" that I didn't have billing issues with the last time.

Also, a car wreck should not be a reason to nickel-and-dime someone unreasonably. And if I knew they were giving me acetominaphen for $1000 and I could wait it out for an hour I'd 100% refuse it and ask a family member to bring me some from Walgreen's for <$10. I'm not exactly swimming in money here.

From this recent HN thread it looks like we still have a ways to go there: New health insurance "transparency data" looks suspiciously wrong

https://news.ycombinator.com/item?id=35347647

Doesn't matter. Nothing has changed.
Somewhere in the hospital conference rooms, a model employee was giving a presentation about "average customers lifetime value (LTV) had increased by 25% YoY" thanks for his hard work. His promotion was finally approved that year. An accountant in an adjacent department was given a bonus for spotting a billing mistake that significantly underbilled a customer with stage 4 cancer. He was made employee of the month.
> The hospital is required to make its charges public. NorthBay Health's online listing shows $547.65 for a rabies vaccine.
Does this price include administration of the vaccine as well or just the cost for the vaccine with syringe and professional services additional?
I checked the price at my local discount chemist. 115AUD or 76USD.
> It's also insane that US doctors and hospitals aren't required to post prices,

This doesn't get a lot of attention because, well, what media outlet could write a positive article about Trump & get away with it, but healthcare price transparency was a big issue of his and during his administration the Hospital Price Transparency Final Rule was established.

The rule was issued by the Centers for Medicare & Medicaid Services (CMS) in November 2019 and requires hospitals to post prices.

The Trump administration argued that the rule would help to empower patients by providing them with more information about the costs of healthcare services, and that it would promote competition among hospitals and other providers, leading to lower prices and improved quality of care.

The rule was initially challenged in court by a group of hospital organizations, but in June 2020, a federal judge upheld the rule, clearing the way for it to take effect on January 1, 2021.