Curious, can you perhaps provide evidence of this? Seems like a good thing to know.
> Call an attorney.
This is itself a cost, and maybe only makes sense if you owe ≥ $10k but for procedures billed as $1k when they should be $400 I don't think warrants the cost and time of an attorney; what other recourse is there except to pay?
I agree that an attorney only makes sense if you're facing a significant bill. On a smaller bill I would go to the hospital billing department and negotiate.
You can of course negotiate as well.
If someone bought a car or house, they knew their obligations exactly. If they declare bankruptcy, I would lay some fault with them, if not all.
But with medical billing, you cannot get a straight answer. If they cannot tell you what a simple procedure would cost you, then you don't owe them anything.
Also hopefully if enough people don't pay surprise bills, then medical industry would have motivation to simplify their systems.
I agree, I do, which is why I tried making my statement as much a question as possible. I am unaware that attorney's would fight for cases like this, if they are more common and do not lead to lawsuits.
I don't get this statement. Not protecting your credit score can cost you real money. Yeah, the whole thing is a racket, and I frickin' hate it, but, pretending like you can ignore your credit score without impact seems counterproductive.
I would really rather see this whole racket of a medical billing system held to account versus advocating that we allow them to punish us in any way for not playing their fraudulent game.
Despite this, I have been able to get a car loan, I got a VA loan for a house, I have opened two credit cards (which I use responsibly) since then, and also was able to get a personal loan for an emergency six years ago. It is absolutely possible to do "normal" things. It's just been a matter of explaining the situation.
Clearing errors involves a byzantine maze and way too much time in an era when everything is digital. There should be stringent regulation around accuracy and we should all have free year-round, real-time access to our credit scores.
But, my point here is not that you can't live a normal life with a few credit dings. It's that those dings represent punishment that can impact you. For instance, you may not have gotten the best interest rate available on your subsequent credit. So, we should be advocating an end to these fraudulent medical billing practices vs accepting punishment from them, then trying to live with it.
BTW, I predict Verizon will soon be the target of some hefty class-action. They are very shady when it comes to contracts. They also have periods wherein substantial numbers of customers report mysterious, frequently dramatic data overages for a time [0] that suddenly disappear. But, they refuse to acknowledge any issues.
And they specialize in making it extremely difficult to achieve resolution, with multiple phone calls, etc.
[0] https://www.wirelessweek.com/news/2016/09/thousands-verizon-...
My perception is that the problem is typically framed as a lack of insurance problem for financially challenged people, but the "abuse" on the billing side to me seems like at least as big of a problem. And if this is being conveniently ignored, it feeds my conspiracy thinking that the Democrats are actually largely indistinguishable from Republicans - they may wear a different mask, but their actions are only slightly different, in this case altering who is getting robbed.
Public option is a great solution, because it does not prevent the people who prefer (and can afford) to pay for private services from doing so.
And that is counting Lieberman as a D; a person who backed McCain for president and who later personally killed the public option.
I do think we will get to the public option at some point. It just makes too much sense not to and would strengthen the healthcare as a whole while allowing people more choice.
And then watched it get blown away by next congress as soon as the GOP gained 51 seats to do whatever they want. Blowing away the fillibuster is an awful, terrible, no good idea and there is almost no legislative agenda which would validate it.
And to be clear, the GOP senators were and still are slimey bastards for basically everything they did leading up to Gorsuch. It should have never been done. They will almost certainly regret it as soon as they lose the senate.
Source: http://voices.washingtonpost.com/ezra-klein/2009/12/the_deat...
By contrast, Lieberman single-handedly killed the public option.
But that's not always the case - Neil Gorsuch was confirmed by a vote to suspend the 60 vote rule. So the rule is available for things that a strong party consensus.
https://www.nytimes.com/2017/04/06/us/politics/neil-gorsuch-...
No, as your source accurately states, he was confirmed after a vote to abolish the rule for Supreme Court nominations.
Both sorts of actions decrease the power of individual senators. If anything, abolishing for a whole category reduces senator's power more - if you also read the article, the basic point is the action indeed altered the power dynamic, what those considering individual senator power are worried about.
However, it remains the case that in 2009, 59 senators were ready to vote for a public option, but there was no 60th. By contrast, there were nowhere close to even 50 votes for removing the filibuster and changing to a 50 vote threshold.
Please do not miss the fact that Lieberman had no rational justification for opposing the public option and that one of the keenest observers at the time accused him of being "driven more by a pathological dislike of the liberals who dogged him in 2006 than by any remotely rational policy judgment." http://voices.washingtonpost.com/ezra-klein/2009/12/lieberma...
Those are the facts. You are laying emphasis on the one person who wouldn't vote and I'm laying emphasis on the 51+ wouldn't take take stronger action.
I think it's reasonable to give my emphasis given the way the Democratic Party has behaved over time.
I suppose that voters could have hypothetically had a positive reaction to the public option once actually set up, and rewarded Democrats for it in subsequent elections. But I doubt it. Although Medicare already exists, the public option would represent a significant expansion which would probably come with serious growing pains - plenty of material for Republicans to make horror stories out of. Probably fewer actual cases of huge premiums (which are already not that common), but it's not like statistics have ever been much barrier to politicians and their preconceived narratives. I guess the GOP wouldn't have been able to weaken the law through a constitutional challenge, as they did with Medicaid expansion - after all, the public option can't be unconstitutional unless Medicare is. But the Supreme Court is highly political, and I wouldn't be surprised if the law ended up being weakened some other way by a 5-4 majority...
But politically, Republicans would have a stronger alternative to offer: ACA without the public option. Y'know, the thing they currently portray as the root of all evil; I think they'd have ended up seeing it as a good conservative compromise, that preserved universal coverage availability without requiring the government to be involved directly. Arch-conservatives might not like that outcome (then again, they might) - but they'd likely accept it as an intermediate step, that still accomplished the substantive change of repealing a huge government program (the public option). It would be much easier to get consensus on than the repeal-in-name-only bills they're tossing around in the real world.
I suppose I'm getting way too speculative; the last two paragraphs aren't even directly related to the nuclear option, although they're meant to question the upside of Democrats hypothetically having deployed it. There would've been serious downsides, not just in health care; it's quite possible the 60 vote rule would end up being killed entirely rather than only for 'special' bills, so Republicans in the current Congress would've been able to pass a wide variety of their priorities, and repeal a wide variety of Democrats'. (For all I know you might support the Republicans on their other priorities, but the Democrats whose votes we're talking about certainly didn't.)
A suspension is both procedurally (or textually) more complicated (it either requires changing the rules twice, changing the rules to add a suspension provision and then acting separately to exercise it, or changing the rules to include a tailored exception that applied only to the case at issue) and more politically fraught (rather than publicly defending the case that the general rule is outdated, it requires legislators to defend that the rule is generally valid but should not be applied to the immediate case.) It's very much not the same thing as abolishing the filibuster for a well-defined class of cases.
This is particularly true in the Gorsuch case where the recent Democratic action to remove the filibuster from other Presidential appointees made applying the “nuclear option” to Supreme Court justices much less “nuclear” than it had seemed previously when it been considered.
1) Indian Health Service - the US agency tasked with providing and paying for Native American health care on reservations or "health service areas". http://www.richheape.com/american-indian-healthcare.htm
How does single payer fix that? If the hospital gives you a bill and won't negotiate down, how does the government "fix" this? Which is kind of what my question is: were specifics given in the ACA on how that problem will be fixed?
On national health insurance (monthly cost depends on your salary but for an average person it is a few hundred bucks per month) the hospital pays 70% and patient pays 30%.
It means basic visits to the doctor or dentist are very cheap here. Like $20 for consultation + medicine. ER+X-rays and MRI (appendicitis, sigh) was a little bit over $100.
If anything, the billing abuse is a much, much larger problem than lack of insurance. At least, that has generally been true since the ACA/"Obamacare" changes passed.
Socializing this theft turns it into Just Another Crisis among the hundreds of others the US has.
The "true" purpose of the ACA was to do something about spiraling health care costs. What was passed was a "compromise" where the people pushing for a public option got nothing and the most onerous restrictions on the monied interests were rolled back. This has not been an effective solution in many senses. I decline to further characterize the issue, however; this is extremely close to a political discussion, and those are ban-worthy here.
I would not put too much weight on conspiracy theories though. The healthcare system is massively complex. It will take multiple reforms to eat this elephant.
My thought experiment for some of this. Suppose the US government had a rider on every insurance policy in the US that said the government would pick up the tab for any amount over say $100,000 (think catastrophe insurance). Now, you would make the assumption that looking at the actuarial tables this would reduce the cost of health insurance because no insurance company is on the hook over $100,000 (thus no need to worry about the million $ payout).
I am more and more convinced that hospitals would screw this up with over billing for every damn thing and every visit requiring a stay would get jacked to > $100,000.
We have a solution. It is called "make it a personal criminal liability". Go after individuals. No matter how low they are on a totem pole and no matter how high they are on a totem pole. Committing such fraud should lead to bankruptcy ( all assets wiped out ) and jail time.
You would be amazed how quick those "accidents" and "mistakes" stop happening.
Unfortunately, as the society we do not want to throw Suzi the billing clerk into the slammer, which means that Mike, the Billing Manager, does not get a slap on the wrist, which in turn means that Jack, the VP of Billing Revenue Optimization, does not get Jackie his wife go bananas on him when their bank accounts, house and kids college fund is seized which means that Jack is represented by the public defender and ends up in a slammer together with Suzi, who actually pushed the buttons, Mike, who told Suzi to do it, and Jack, who came up with this wonderful idea.
The provider must set a high sticker price so that they can give the insurer the expected 60-80% discount to get in-network (and still tolerate underpayment and other shenanigans). The consumer is either intentionally misled or confused (usually both) about basically everything cost-related, and often won't learn the true out-of-pocket cost of a service until ~1 year after receiving it, when the billing process has (mostly) finished.
Example: just yesterday I got a new bill for a routine lab test I received in December. It says that the insurance discount applied, but they never sent a payment, and thus I owe a balance of over $200 to the lab company. Now I have to call the insurer to figure out why they denied payment, which is sometimes due to an administrative error, sometimes a paperwork thing like signing a document that verifies there is no other possible insurance carrier whom may have been responsible for the bill, etc.
Obamacare is thus anything but up front, because honestly working to fix the American medical system would involve excising market-breaking, paper-pushing leeches from the marketplace, but Obamacare props up this destructive apparatus by forcing every American to pay in or get fined.
Almost any economist will say this is one of the largest problems with US health care costs and employment mobility.
Every employer outside of the health insurance and drug industries should be furious at the price they pay to pay their employees health benefits. Besides having a distraction that operating businesses in other nations don't have, they're likely paying more than double than what they need to in this area to maintain competitiveness against other nations. It's even worse for startups.
It also probably should have used subsidies instead of Medicaid expansion. Expensive, but a bunch of healthy people would have been good for the exchanges (Medicaid expansion almost by definition was for healthy working people).
http://www.cnbc.com/2015/11/20/obamacare-architect-high-dedu...
The previous administration was working to move to different payment models to try to address it (it's not clear that the different models will have much long term impact):
http://www.reuters.com/article/us-usa-healthcare-reform-idUS...
Any number of effective cost-saving measures could be passed that would have the effect of increasing your premiums.
As for the increase premiums are up 25% in 2017 alone. At the same time deductibles are also rising, its much more money for much less coverage if you are unlucky enough to make over 50k a year or so.
http://fortune.com/2016/10/25/obamacare-insurance-premiums-2...
https://www.brookings.edu/wp-content/uploads/2016/07/Fall201...
It's remarkable that premiums didn't rise more under the ACA, despite how many new previously-uninsurable people were covered.
If you're paying for your own insurance, you're in the individual market, which is significantly more expensive, and what you're seeing is, in part, the market absorbing the cost of guaranteed issue, something we decisively did not have before the ACA, when health insurers could lock people out of coverage on suspicion of a medical condition, and later rescind care. Pre-ACA and post-ACA insurance is for that reason also not an apples-apples comparison.
Regardless of the cause, it's extremely frustrating to be hit with such a large monthly bill for rather poor coverage. I'm not quite as bad off as 0xbear, but we're at $1550/mo for a family of three for much crappier coverage than we had a few years back.
Here in Phoenix we've seen double digit increases every year for years, and are down to a single provider on the individual market.
Paying $18k/yr before you even use a plan is insane. Use it at all and you're looking at $20 or 25k total, with coverage limits not really kicking in to stop the bleeding until you've shelled out 30k or so.
Somebody making $80k/yr just hits the subsidy payout and is spending 20-40% of income on health care. Unsustainable.
Argue the whys all you want, these sky high rates have to change.
If you don't argue the whys, you're mostly providing a lot of noise that is convenient cover for the next attempt to bilk insured people.
Yes, premiums are way too high. They are not high "because ACA", though. In fact, they'll rise at a much faster rate if we get rid of ACA. (The latest bill had an annual rise of $11.4K for a single male adult >62 years, with an annual income of $12K.)
There's no question ACA is broken, and we need to fix it. But we need to know and understand what is broken to fix it. A repeal won't do that.
There's a good argument to be made that e.g. enforcing cost transparency would do that. (Right now, you have no idea what insane cost your provider will charge you - they make shit up as they go). Single payer is one possible way to do that. Not the only one.
There's another good argument to be made that we need to talk about the right to die. Numerous patients are kept alive at insane costs, even though they would rather live out the last few quiet moments at home, with their family.
There's another good argument that for a decent risk pool, everybody needs to be insured. (This is an argument that stands little chance until being insured is actually somewhat affordable)
There's a good argument to be made that Medicare should be allowed to actually get competitive bids. (Right now it's rejected to "pilot projects" and "test markets").
There's a good argument to be made we need to focus much harder on preventative care. Follow-up costs from acute episodes are much higher than a decent investment in preventative care.
There's a good argument to be made we should talk about our test and prescription obsession. The amount of stuff unnecessarily prescribed "just in case" is ludicrous.
None of these will immediately lower rates. But each day we spend wasting on the theatre that is the junk the current GOP tries to ram down everybody's throats is a day they rise. And should this pass, they'll rise tremendously.
If we don't all inform ourselves as to the why's and then hold our representatives feet to the fire using well-formed arguments, so they can't weasel out, we're stuck with a shitshow. So, while I understand the frustration - I've got health care bills too, after all - an attitude of demanding change without informing ourselves what change to ask for leads to an even worse disaster.
And that feet-to-the-fire thing applies to all parties, in case you were thinking I have a particular partisan view. But it needs to be an informed roasting, or we'll merely end up with the loudest guy making the good sounding promises.
I'm ranting against those who continually tell me "it's not that bad", "suck it up", "you're lucky you have insurance" or some variation of the above.
The first step in fixing the problem is to recognize the problem, and there's many I've talked with that reflexively reject the premise that there is a problem in the first place because of what that means for the ACA.
The foundational issue is that we're stuck in an uncanny valley between single payer and private insurance. Either single payer or private could be viable, but not the unholy menagerie we have now.
The high costs, over prescription and under prevention that are bloating the system all driven by that issue and could be solved with a single arbiter that gets the bill, whether that be the government or the citizen.
The best proposal I've seen is a two-tier system like Germany has, with public healthcare for all and private healthcare available for the rich. That tends to rub Americans the wrong way because fairness, but really solves most of the problems because it gets universal coverage to spread the risk pool while accepting the natural impulse to want to pay for better care if you can rather than rejecting that option out of hand like some single payer systems do.
I lol'ed. Because... we already have private healthcare for the rich, we just don't have public healthcare for all. Because fairness ;)
And I'm very much enamored with the German system as well, but then, I'm biased. I'm from there. (And currently pondering going back there, because as much as I love what the US could be, I hate what it currently is)
Is the actuarial and outcomes data corpus of the health insurance industry so bad that it makes actuarial sense to segment the markets to individual, medium group, large group, etc.? I've always wondered what the explanation is for so many cohorts.
Are state insurance regulations preventing medical insurance providers using more sophisticated risk modeling to create larger pools, or co-marketing with life insurance companies that gather pretty detailed data on individuals before underwriting?
Especially post-ACA, there are very strict limits on what factors can be used to set premiums. Risk-based assessments are basically outlawed except for a few defined variables like age and smoking habits.
The NHS costs about £3,500 a year per person.
Without adjusting for inflation, this growth is ~60% growth in 6 years, or a doubling time of ~9 years. After adjusting, it's more like 40% over the same 6 years or a doubling time of ~12 years.
That's why factcheck should not be used to check... facts. Just as they claim the RNC have twisted this and that to make themselves looks better factcheck is twisting things here as well, to make someone else look better. Health insurance providers had raised premiums in anticipation of the vote and the legislation passing. So it's specifically important to look not at 2010 when it was signed into law but a few years below when there was this uncertainty about it. One way market deal with uncertainty is to hedge their bets. "Not sure what will happen, but this might pass, and why don't we just raise the rate now" kind of idea.
I've heard this directly from the health insurance representative who came and told us told us, "sorry but rates are going up sharply because we anticipate this new legislation".
But they did during 2009. By July, a number of bills were already approved by committees in the House. And the Fall is usually when the companies get prices for the next year. So it went up sharply then. Then in again in 2010. Price is not always comparable because the level of coverage had also changed. We had to get new plans and while they covered some mandatory free procedures and didn't have lifetime maximum, they had also bigger deductibles and a reduction in options and procedures covered.
That doesn't mean we'll find a larger jump there, I found it for my self, but the KFF study shows there wasn't in general. However discarding date legislation has passed is also dishonest as factcheck did. Companies which are affected by regulations monitor them closely and adjust to them correspondingly.
So you could have the impression that you had "cheap insurance" as long as you never need to have significant healthcare paid for.
The very year ACA took effect my health plan was canceled, my doctor went off-network, my new plan had 3x the annual premium and has grown 30% year over year, as have deductibles, and I fight tooth and nail every single charge to make sure it is in network and covered.
Yes, one anecdote is not data. But there is no more validity to the politician's lie that I can "keep my health plan, keep my doctor, and health care costs will go down."
Same here, and I hear the same exact story from most people I talk to. Plans dropped, premiums skyrocketing. Here in Phoenix we've got a single insurer left, and we'll see if we have anybody next year.
What I haven't seen is stories of average joes who were substantially helped by ACA. Sure, if you didn't have coverage before by cost or pre-existing condition, or get subsidies now, maybe you're happier. But the vast middle class, not so much.
So there's a face for you, 32 year old, healthy, middle class, white woman who likes cats, rides horses, and has a pet bearded dragon who she talks to in a baby voice can get regular cancer screenings because of ACA.
Post-ACA, I could once again buy health insurance.
I consider no longer being locked out of the US medical system a substantial help.
Consider also the not middle-class recipients of medicaid expansion.
Something like 80,000 Floridans lost that policy because it didn't carry the minimum services under ACA/Obamacare. But it wasn't just losing the policy, they were never able to afford the new blue cross blue sheild policies, having to purchase from a new insurer most of whom had reputations as fly by night operations (many not existing before ACA and shutting down 1 and 2 years in), and finally losing the good BCBS network.
Here is a copy of the actual letter sent out by BCBS when they had to cancel the policy: https://www.floridablue.com/blog/my-policy-being-canceled-no...
If that's the case, then the difference between Democrats and Republicans is that the Dems want to insure the poor while still ensuring high profits for the industry, while the Republicans want to screw the poor while ensuring high profits for the industry. They differ on one very important issue, but are still mostly the same.
Actually reducing medical costs requires a far more thorough overhaul of the system.
Also: this idea that the "Democrats are the party of the people" and the "Republicans are the party of corporations" is pretty silly.
The Republicans are a conservative political party. The Democrats are a coalition of blacks (~25%), latinos (~10%), women (+10% share), labor unions, and urban (but not suburban) college-educated whites. Liberals are an important component of the Democratic party (and have no home whatsoever in the GOP), but they don't run the table.
Republicans can't win the numbers game so they hammer home on right wing populism. Unfortunately, the last 30-40 years hasn't been kind to the "Main Street" centrist republicans of the past.
It hasn't been like this since LBJ. Both parties are completely driven by corporate lobbies. All that differ are the excuses why.
Probably the most important realization for the average American in the current political climate is how no party establishment represents you. Both have their sponsors, and none of them are the American people. Individual politicians might have more empathy than others and some might try to help the common man more than another, but they all still have their bosses and despite whatever rhetoric we throw around in almost every election (aside the scant few in contested states and counties) the people are not holding their leash, so they don't work for you.
It is like climate change. It doesn't matter how you want to argue about solving it, it is simply acknowledging the reality that has to happen first and moving on from there on a unified foundation of fact.
A lot of people forget that the GOP does not, as a political party, believe in universal coverage. Moving the country closer to universal coverage is not a GOP political objective. What is a GOP objective is minimizing federal interference and involvement with business. Health care is something like 15-20% of the entire economy, so the GOP's stated objectives run directly counter to universal coverage.
And yet, repeated efforts to eliminate the ACA have all retained policies built around universal coverage, including a massive federal expenditure in Medicaid (block granted or otherwise) and an extremely intrusive regulatory requirement for guaranteed issue insurance, something that only Ted Cruz has tried to push back on.
If that's not a win for the Democrats it's hard to imagine what plausible outcome would be. Nothing that involves 15-20% of the American economy will be simple, or will happen in one legislative session.
It only makes sense to at least postulate that the converse is true as well: if you find yourself stuck out-of-network, it's because these regulations created an environment where the insurance companies could do better by eliminating the providers it partners with. So it's reasonable, at a first approximation, to guess that this problem is the result of ACA.
We need a single payer system because, at the societal level, it makes sense for government to make sure people get their healthcare needs met for the same reason it makes sense for government to provide police and fire protection. But forcing all Americans to get private health insurance makes no sense and indicates a fundamental misunderstanding of what the insurance industry does.
Direct Primary Care, single payer and wellness programs all have a good track record of genuinely getting people healthier while bringing down costs. Obamacare cannot do any of those things and just runs expenses up.
Source/qualifications: Among other things, I worked in insurance for over five years. I have a certificate from a technical college in life and health insurance, paid for by my former employer.
Have you been watching anything that's been happening with the healthcare debate over the past, oh, 25 years? The Democrats have been trying with varying degrees of success to inch this country in the direction of a more sensible healthcare system and the Republicans have pitched a generation-long hissy fit about it.
It's been that way for decades.
On the coverage side, the two parties have contrasting stances.
Healthcare and Health Insurance are related but distinct topics.
I'm actually not sure the BHCA or AHCA or whatever it's called now has much in it besides slogans and major spending cuts which aren't aimed at making care less expensive -- they're aimed and reducing the overall amount of care provided by shifting costs to those less capable of bearing them.
That's a pretty big contrast.
Cost of healthcare, other than the occasional conversation about drug prices and definitions of necessary care (which continues to be abused by practitioners), continues to take a back seat.
For what it is worth, my personal opinion is that the medical professional lobby is a single issue voting constituency that is just as powerful as the NRA and the teachers unions.
Until then, I will continue to believe democrats and republicans serve the same master and only differ in language to provide an illusion of choice.
What a terrible industry.
The employees at an insurance company have an ethical responsibility to the company to deny any claims that do not perfectly align with the policy they sold. I don't think every insurance company is the antagonist in The Rainmaker or the car company in Fight Club, but insurance companies will try to reject as many claims as they can, straddling the line of losing reputation with consumers.
the health insurance industry shouldn't exist.