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Comment by ohazi | Hacker News Reader

This makes my blood boil.

This is the sort of thing that health insurance is supposed to be used for - potentially life-threatening emergencies that need a fast response time, and that may require expensive treatment.

Medical insurance companies are dropping support for expensive ER visits, and instead supporting "preventive care" by only covering a $100 annual checkup instead (which is predictably scheduled, and can often be paid for out of pocket).

What's the fucking point anymore? This is no longer health insurance, this is paying $3000 a year for a $100 checkup. Americans should be rioting in the streets over this.

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Does your blood not boil that the original charge is of 12 thousand dollar?

> The doctors in the emergency room did multiple tests including a CT scan and ultrasound. They determined that Cloyd had ovarian cysts, not appendicitis. They gave her pain medications that helped her feel better, and an order to follow up with a gynecologist.

> A few weeks later, Cloyd received something else: a $12,596 hospital bill her insurance denied — leaving her on the hook for all of it.

For a few tests, the hospital charges 12,000 dollars. How is this sane? People should be rioting over this.

The most crazy thing I find, outside of the cost, is the doctors were uncertain and ordered those tests, but then the insurer say : the tests were negative so we will not pay.

It's not like she decided herself to administer those tests ...

They really should. My wife had a similar issue - charges were not nearly _that_ much.

Albeit, one of the larger ones is STILL in negotiations between the hospital and the insurance company.

The worst thing in all of that is how accepted it became in US culture.

Emergency visit or medical treatment requiring remortgaging, debt or spending otherwise life savings are used as a background plot mechanism.

When I was younger, money was the plot (and that was already depressing enough): valiant doctor fighting to avoid their patient to have crippling debts, but now, often it is part of the background. Of course cancer is going to ruin you, everybody knows that, so let's build drama on top of that. Doctor are uninterested in making it cheaper, all is based around choosing health or money.

I would guess that it’s actually that staff are more interested in avoiding the liability when they don’t order a required test. Like all big problems there are many parts to it.

Yes, absolutely, this too is insane.

The bill was based on what insurance company would pay, or as the opening gambit in a round of negotiations to get the insurance company to pay a reasonable amount. An individual could probably get the hospital to knock a '0' off, but even $1,200 for an emergency room visit is too much to expect a person to pay.

It's been demonstrated that when people have to pay for ER visits, they stop going to the ER. And, from past experience, anytime there is pain in the gut, even doing the "right" thing and going to an urgent care clinic first will get you turned around right away and pointed at the ER.

For the record, I don't agree that it's the "right" thing, but it's required by some insurance companies.

So we all agree we should be rioting. Good. But, um, I'm afraid I can't take the risk of being injured in a riot - I don't have $12k to blow on a trip to the ER (I spent all my money on premiums). So, y'all go ahead without me.

We recently had to do an ER visit. Simple stitches + observation for 3.5 hours. 4 hours in total. $7,900 billed to the insurance. Looks like they will pay most of it.

What pisses me off is they have some bureaucrat walking around the building, walking into various ER rooms, does absolutely nothing, stays for a minute, leaves, and then it shows up on the bill as $1000 with some nonsensical description.

>>How is this sane?

Its just one of those functional test cases, capitalism fails as a system.

Hospitals/Doctors/Clinics look at purchased equipment as something they need to make money on. So they have to keep them working. Its really no different than workers doing in 24x7 shifts to keep machinery in the textile mills working all the time. Human labor is cheap, and money gets made by putting in energy into the machine and selling the output of the machinery for profit. So in this sort of a system, you can only make profit by keeping the machines working, as the human labor required to make them work is cheap, and the profit is made by selling the output, keeping the machines idle means loss.

Its just that when you apply this to a hospital the model breaks down. But most of us are ok with this model if we get to buy jeans pants at Costco for $14.

Insurance as a work around doesn't fix anything in this system as you are just passing around the burden of paying for non-productive output of a process around until some one can bear the loss. And no one will.

My wife had exactly the same issue. We went to ER with pain that looked like appendicitis, but after the tests and a night at the hospital (they checked her in for the night) they found out it was just a cysts and we could go home with some painkillers. The twist to that story is that this happen in UK and on the end of the day we just said a big "Thank you" to whole staff that took care of her and that was it.

Couple days ago there was discussion here on HN, how we, Europeans, are so braging about our health and support for citizens systems but we still earn peanuts in comparison to US. Well this is exactly the reason why I prefer to earn £50k in UK rather than $150k in SV. This $12k bill from the article is not that bad, but it could easily end up with $120k if she would have something that require surgery.

It really does seem like Health Insurance is heading in a backwards direction. They cover the small, predictable costs (annual checkups, routine blood tests, etc), but continue to find ways to pay less of the "major" events.

Imagine if your car insurance decided to cover oil changes, but not at fault collisions. That would be asinine.

It is interesting to compare the sentiment in this thread and one from a few days ago: https://news.ycombinator.com/item?id=16208210

When considering whether to get a flu vaccination the recommendations of health insurance companies seem to be treated as gospel...

I agree that Anthem is in the wrong by denying ER coverage in some cases, but let's keep the discussion free of hyperbole like this:

> insurance companies are dropping support for expensive ER visits, and instead supporting "preventive care" by only covering a $100 annual checkup instead

This is quite far from the facts of the story and does not belong in an honest discussion (note: I'm not arguing that Anthem is in the right at all, I'm just arguing that this is not a good description of the situation at all).

If you're an anthem customer you can't safely go to the ER to deal with unknown and possibly life threatening issues.

Saying Known issues are covered is meaningless.

The only response to this is to either sue them or switch coverage because they have failed to provide the services you have paid for.

> If you're an anthem customer you can't go to the ER to deal with unknown and possibly life threatening issues.

As a different anecdote, Anthem paid all of my cost for an ER visit last year (minus deductible). It was a first time thing. That's why your parent was asking you to avoid hyperbole.

You missed my edit I add safely, because in these states that's what's missing.

Yes, if you are actually having a heart attack or a bone is sticking out then sure they cover you. The problem is in situations where you don't know and need medical experts to chose if this is an actual emergency. And no this is not hyperbole, that's the exact situation people in these states are dealing with.

This is not call them up on the phone and they say you can go to the ER, this is you go to the ER they preform tests and then the insurance company uses those results to deny clams.

Agreed.

The sentiment "American Healthcare isn't as bad as people say it is!" has become a defense mechanism.

As in, its purpose is not to ensure that a discussion is reasonable, but to make the speaker feel both superior to, and insulated from, the problems killing fellow human beings.

Pretty sad.

We have anthem and have had no trouble getting anything paid for that is covered. Including an ER visit that turned out to be nothing.

A) What state is this, because the policy only applies in a few states?

B) What time was this because it's a recent change?

Based on the article I suspect your experience has little barring on this situation.

I agree with everything you said. That still doesn't equate to "nothing except for $100 yearly preventative checkups are covered" though, which was my point.

Keeping heated discussions honest is important, regardless of which side you are on (and I'm on your side).

I'm reminded of a quote and I forget the author and I'll probably bungle it; "Any long running business eventually becomes indistinguishable from a scam".

That would imply that all of the companies listed at https://en.wikipedia.org/wiki/List_of_oldest_companies are scams. Which seems excessive.

I'm confused by this response. This is par for the course.

Anecdata: I have never had my insurance company cover anything in the last three years.

The best they ever do is claim to negotiate a slightly lower price, for which I still pay out of pocket.

And when the annual "maximum out of pocket" gets surpassed, they gamble (correctly) that I won't incur the costs associated with litigation when they inevitably continue to deny claims after "maximum out of pocket".

There's very very little we can do.

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