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Comment by byuu | Hacker News Reader

My employer/provider (Blue Cross) offered a $100 discount on insurance premiums in return for me taking a vial of my own blood and mailing it off to them for testing.

Although I am in (mostly) good physical shape, I found it beyond creepy and refused to do it. But I worry about them increasing the discount in the future. It'll be harder to say no when it's $1000, or $2000. And let's be real: it's not a discount, it's a penalty for when you don't do what you're told.

And given how my insurance doesn't even cover a 30-minute ER visit without sending me a bill in the mail for $1700, it's hardly even worth having insurance at all. At least at my age.

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>>> And given how my insurance doesn't even cover a 30-minute ER visit without sending me a bill in the mail for $1700, it's hardly even worth having insurance at all. At least at my age.

Until you show up uninsured at the same ER for the same visit and end up with a $10,000 bill because you don't have insurance.

Whether it hits your deductible or not, insurance negotiates rates that are easily 75% cheaper than what you'd pay without it.

> Until you show up uninsured at the same ER for the same visit and end up with a $10,000 bill because you don't have insurance.

That's the problem, though. If I can't afford it, then it doesn't matter whether they charge me $1,700 I don't have, or $1,700,000 I don't have. Either way, I'm not going to pay it, and it's going to end up going to collections and dinging my credit.

Let's say the worst possible case happens and I get cancer. They don't treat you for that in the ER, other than the bare minimum to keep you alive. But to get those ungodly expensive $3,000 a dose drugs would require too much out of pocket. I wouldn't be able to get them with or without insurance.

If you come in with a cash payment offer you can likely get the same discount. You do have to be willing to do a bit of negotiating however. Because nobody without insurance is actually paying those $10,000 bills.

That is false. You will typically get a 10% or 15% cash discount from the hospital ticket price. Still easily 3x what an insurance company would negotiate for you.

Some hospitals allow you to fill out extensive paperwork to apply to have greater bill reductions, and you need to send in several years of tax returns, bank statements, a personal financial statement, an explanation of your situation and why you can't pay in full, etc. It's a grueling, paperwork intensive, and invasive process.

So where in the world are there services you can pay to negotiate your bills downward without keeping them on retainer?

A great way to coerce individuals into having their genetics profiled so it can be used in business decisions. This is amusing to me as a biologist, because the methylation apparatus and mRNA splicing suggests that etiology of "genetic disease" is vastly more complicated than simply possessing certain mutant alleles. Though, certain genetic diseases do proceed in this manner, and the mission of molecular biology going forward is to develop methodologies which approximate hardness in an intrinsically chaotic system. Large sample sizes, meta-analyses, etc.

This is one of those "preliterate peoples do not develop epidemic myopia" sort of things, perhaps.

Jesus. My ER copay was $50. How much per month is your plan?

I don't actually know how much my plan is per month. It's not clearly listed anywhere I can find. It's the top plan my company offers, though.

Here's the actual ER bill as proof of what they charged me:

https://twitter.com/byuu_san/status/776137889348358144

> I don't actually know how much my plan is per month. It's not clearly listed anywhere I can find.

The amount you pay every pay period, to your insurance plan and to your health savings account (if applicable), really ought to be on your pay stub. If you're paid electronically your company probably makes that available to you somehow via pdf.

Yeah, but they do an $8,000 CAT scan when you're in the ER. Not $50 any more.

Yep, exactly. They don't tell you how much it costs, and how little your insurance is going to cover. And they also don't tell you that they could've detected kidney stones without a year's supply of radiation into your abdomen, and without all the expense, by using an ultrasound instead. You learn that after researching the matter after you feel better and get your bill in the mail.

You go there in the worst pain of your life (kidney stones are truly terrifying), and you think they're there to help you. Not use you to pay for their fancy, unnecessary, dangerous toys.

Well, I'm talking about the out of pocket expense when you're covered. My ER visit wasn't $50 either, technically; the ambulance bill alone was 50x the copay, in the itemized bill they mailed me. But I was personally responsible for very little of it.

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