Sounds all fine and dandy until you realize that these charges will just be made up for by people that aren't able to get NPR to publish a story about them.
And, to be clear, they charged $19,000 for the stent, not "stent plus theater time to place it plus surgeon, anesthesiology, OR nurses", of course not. Those are all absolutely billed separately.
Also, in speaking with a vascular surgeon I know, their hourly rate is between 200-350/hr. The middlemen and hospitals have figured out how to milk this cow and they're feasting.
It took 2 months for the bill to arrive.
Healthcare in US is like legal extortion. You could literally bill for breathing hospital air and people would have to pay.
Don't be ridiculous. You'd be billed for air and hospital odor separately!
Though I should note that a delivery is usually more complex than simply waiting there for the little one to fall out, there is some after care and such that is being performed plus the doctor is usually not that cheap either. (They have a lot of student debt to pay off after all)
There is also a huge industry built along the lines of phony testing.
The term used for that think is called 'basin test', basically samples are flushed down the basin and made up numbers are put in reports. You can put in what you like as the doctors know the patient is healthy.
If I can source the same stents for cheaper than the hospital bills me, they should be required to erase them from the bill and accept them as material replacement.
It's not as if medical supplies are unavailable to the end consumer.
https://www.esutures.com/product/0-in-date/41-boston-scienti... Here are the stents available for under $1000.
When I had a broken finger and was uninsured, I was charged ~$40 for a finger splint that costs $7 at Walgreens (yeah, the very basic one made out of aluminum and blue foam).
Also, a word of advice - never ever pay what you were sent from the hospital right away. I personally throw most medical bills in the trash and wait until they call me, then negotiate it down to a fraction of what was billed, offering to pay in cash.
> If I can source the same stents for cheaper than the hospital bills me, they should be required to erase them from the bill and accept them as material replacement.
Meh. The only reason they inflate supply costs is because that's where insurance negotiations let them. Mandating supplies must be available at-cost to consumers is just a stupid cost-shifting game. Consumers shouldn't care in particular about the cost of supplies — overall cost is what matters.
Price-fixing in general does not really work. The difference is made up somewhere. Things that would actually reduce pricing stupidity and surprise bills are obvious things like: increased pricing transparency, consumer stake in reducing costs (HDHPs are a stab in this direction), and single payer.
Healthcare can and should be heavily regulated, its not like buying a hammer.
I agree that regulation makes sense, just not with the extremely specific proposal that medical devices be sold at cost (or whatever slightly higher unit cost is available to consumers).
https://www.commonwealthfund.org/press-release/2017/new-11-c...
> Mandating supplies must be available at-cost to consumers is just a stupid cost-shifting game.
That's not what I suggested in my post at all.
Also, if it reduces costs for the end consumer, what's the harm? Why should consumers subsidize hospitals with cutthroat billing departments who make up numbers out of thin air?
Not trivially? [1]
[1] https://www.theguardian.com/society/2017/jul/18/uk-cancer-su...
Yes, mandating supplies be sold at-cost is exactly what you proposed:
> Hospitals should be legally mandated to accept replacement of materials in lieu of payment.
> If I can source the same stents for cheaper than the hospital bills me, they should be required to erase them from the bill and accept them as material replacement.
And to address:
> Also, if it reduces costs for the end consumer, what's the harm?
The problem is in the condition. At the end of the day, ineffective regulation increases costs for the consumer.
> Most do not have the time or expertise for that, nor would anyone want to do it.
Is that a joke? You can find most of those things with a 30 second Google search. I thought this was a forum with technically apt people?
Less profit for the company.
This is actually good advice. It shocked me when I realised it. But it’s good advice.
They ended up dropping the bill altogether as insurance had already paid them.
I know the US system is different to what I grew up with (UK NHS), but I have had similar "treatment" when ill as a tourist in 3rd world countries: couple of pills / drip.
I understand that the difference of systems in regards to extensive care, but a couple of pills and a drip - why on earth is such basic care just not free to all?
I mean, I know this seems like just a snarky political comment. But it's just the honest answer. Our federal government is simply completely dysfunctional right now, incapable of solving anything.
For what it's worth, "Medicare for All" has been polling increasingly higher recently, due to more Americans being basically ready to give up on the current private system entirely.
Just now? It’s seemed dysfunctional to me since I was capable of understanding government, circa 15 years ago. My parents felt the same way 30 years ago, and their parents felt the same way 50 years ago.
The supply chain has to be verifiable as genuine goods from the factory to the hospital floor. Trying to verify the authenticity of patient-supplied replacements would be a nightmare.
I wasn't actually seriously suggesting that patients be required to source the item physically, then physically deliver it to the hospital in person.
My situations varied, but when I had no insurance and was living off of savings, I found a generic "hardship" form and explained my situation to them - they waived 80% of the fee without much resistance. This is compared to the laughable discount of 2% they offered me on the spot if I paid in cash (at the moment of the visit)
In other situations, I'd imagine it's more a question of persistence, but I'd venture to say you can knock off at least 50% on _any_ hospital bill.
I recently bought a house, and my credit was 800+, so I don't think it does in any appreciable way.
That wasn't the gist of my post though. I was advocating more to resist the bullshit and to legislate something that allows the customer to replace materials instead of paying a hugely marked up item.
Same concept would be applicable, for example, for a car mechanic shop. Just because they billed me $600 for brake pads doesn't mean that they've actually provided me with a 10x markup of value on having bought brake pads myself for $60 - at some point this needs to be treated as "usury" (I don't know if there's a word for exorbitant markup on a regular good).
Another thing I would add - don't put your social security number on medical forms. I've never seen it enforced and there's no medical reason for them to have it.
Also, people like you who force hospitals to chase you down to pay a bill are part of the reason why it's so expensive in the first place.
$10,920 for room charges is absolutely ludicrous.
About 5 years ago, I had 6 weeks in hospital, a total of 3 angiograms, one MRI scan...and then 5 stents (should have been 4, but they tore something and had to put in a covered one!).
The wait was mainly down to an unfortunate series of events: One stent was needed in a 'tricky' place and so I was timetabled to be operated on by a specialist surgeon elsewhere, but his father fell seriously ill so he went on leave. My first op was rebooked for another hospital...and they had a 'flu outbreak so ops were postponed. Eventually I was booked in elsewhere had a one hour ambulance transport ride for 'third time lucky'.
The stents were fitted in two separate operations about two weeks apart. The most notable expense I incurred was for data top-ups on my cellphone because hospital wifi was still being setup and hadn't quite made it to my ward.
The NHS gets a lot of flak, and it's by no means perfect, but it's generally there for you when you really need it.
PS: I'm on a slew of meds for my heart condition and T2 diabetes - all free at the point of collection.
I'm asking because a friend was in the hospital in the bay area for 7 days and his room and board was approximately $21,000
In regard to your friend ... his 7 x 2 = $14k. That's a LOT for basically a bed, blood draws daily, limited TV and cafeteria food, but in the center of Los Angeles, that's what you get.
Hell one time I got a $15k bill for something insurance should have covered. Called the hospital, turns out insurance had covered it and I didn't actually owe any money at all. How many people get this kind of stuff and just pay it anyway?
> Hiring someone became imperative for me when coordinating my mother’s care got to be a way-more-than-full-time job. (In retrospect, I wish I had done that months earlier.)
> It could also be worthwhile in less critical cases, if no one in the family can take enough time off from work, or in which you’d simply rather pay someone else to clean up after a hospital’s paperwork pollution.
> This role has developed only recently, as systems have broken down. There’s not yet a standardized term; “health care advocate” is one among several.
> Mine specializes in gerontology and dementia. Others specialize in other disease areas; or in other aspects of the administrative nightmare, such as sorting out bogus hospital bills, which frequently include fraudulent additions.
> They are not inexpensive (mine charges $150/hour), so not an option for everyone.
> There are good and not-so-good advocates. I spoke with several before hiring one. Some were clearly clueless; the one I hired last month has seemed consistently competent.
> Since they recommend particular providers, there is an inherent principal-agent problem. Ask if they get any compensation from services they recommend. Take their recommendations with a grain of salt in any case.
I went through surgery at the Stanford Hospital, using Stanford's insurance. Prior to the surgery, they charged me $2000, the out of pocket maximum. Then, a couple of weeks post-surgery. I got another $250 bill. I had to spend the whole day on the phone first with the hospital, then the insurance, and then the hospital.
Turns out, that all I had to pay was $250, that the hospital had made a mistake in billing me $2000 at the door. I got my money back a month later.
I would normally attribute this to ineptitude. But the frequency and scale with which this happens, reeks of widespread scams.
I'm much less worried about the folks who pay it anyway than I am about the folks whose lives are destroyed by an industry predating on people in the worst of circumstances.
https://gist.github.com/ndarville/4295324
I'd start with a mentally forced mashup for each to get a few that might work. e.g. "If i've got to make money by lead generation with a medical bill review service/app, how could i do it?"
Then i'd focus on how we'd drive value to the consumers.
Then think about driving value to others parties who may be willing to pay for something similar.
ie would pharmaceutical and medical device companies be willing to communicate directly with these consumers?
note i'm not saying its easy by any means, but i do think its a real problem that could take off if an elegant and worthwhile solution came about.
But then I almost had a hard attack when the statement arrived. The first number I saw was 24k, WTF!! Well, reading on there was a very large "discount" applied and the final bill to the insurance company was about right. I could only imagine though, that under some circumstance, the hospital would have tried to stick me with that totally bogus 24k bill had the insurance not covered it or the pricing not been negotiated in advance..
I'm not saying, "ignore it and it goes away." Just that the billing side of things has no interest in working when they already have your money.
She told them "I'm on Social Security for $1000/mo, I'll pay you $50/mo". It was basically that or sending it to collections and never getting a dime from a retiree. So they accepted and told her a "non-profit" paid for the doctor's portion of the bill, which was all but about $40k.
She'll probably be around another 10 years max, which means she'll end up paying about $10k of that balance.
Medical debt is the least concerning type of debt for most lenders. If you ever fall into this hole, don't sweat it. [Unsolicited advice.] Just let it go to collections. You'll get harassed for a little over a year. Debt older than a year is almost never pursued by collections agencies. After things quiet down start sending letters to the credits agencies saying the collections debt has been settled. The collections agency will usually slip up and not respond at some point and it'll be gone from your credit history.
Total cost, something around $23,000 I think. This is somebody who was making maybe $10/hr. They took a payment plan of around $15/month, so she will be paying it back for the next 128 years.
Recently she got a bill for $250 for the ambulance, which she paid, and another letter saying her bill for the hospital stay was settled. She told me she would have offered $15/mo had they held her to the $25k or told them to screw off if they didn't accept. They're not even bothering anymore.
Just another data point, a large property management company I used to work for specifically exempted bankruptcies due to medical debt when calculating applicant credit scores.
Also, if you're ever called by a collections agency, you should ask them to provide proof that they actually hold the debt you're obligated to pay. In some cases they've just bought the data, usually from another collections agency who couldn't collect, and they're trying to shake you down. Once you use the magic phrase "provide proof" they give up and stop hassling you, because they have no proof.
I wonder what would happen if it was widespread knowledge that the smart money was in never paying it.
I've had 4 different cell phone numbers in my lifetime. All of them were still getting debt collection calls or still are up to 15 years later. I've had my current number for over 15 years. I'd love to meet Tanya who ran up the bills for my current number.
Also, I had my appendix rupture right after getting laid off and going on COBRA. I am still getting occasional calls about that even though the insurance eventually paid off. That was over 10 years ago.
COBRA is another scam. $1650 per month that my employer was paying ~$600 for.
Scumbaggery is rife in the insurance industry. The Rainmaker should be required watching...
COBRA is whatever the employer was paying + 2% administration fee.
I don't understand. Is there no penalty to not paying other than a hit on your credit score? Can't you end up with wage garnishments or liens or something like that?
Yes, the hospital or collections agency can sue you to try to garnish your wages. If they win, you're boned.
If they lose, or they never sue for garnishment, it's unclear what happens if you refuse to pay. From what I can tell, the debt disappears from your credit report after seven years, but the debt is still valid and they can still try to recover the money from you, but they won't be able to use the courts to do it.
However, there's always the option of declaring bankruptcy. Even if they garnish wages, declaring bankruptcy will wipe it away. Obviously, that's the nuclear option and will destroy your credit rating for seven years.
No, St. David's has already fully recouped their costs and then some. They were simply trying to extract as much money as the stone could bleed.
sources:
https://www.beckershospitalreview.com/hospital-transactions-...
They came by the name honestly, but it is indeed a shame the way it has gone since the St. David's Foundation partnered with HCA.
The hospital(s) were originally founded and run by St. David's Episcopal and were one of the first and foremost hospitals in Austin, with very high quality care and good service to the community.
After operating them for nearly 75 years, and growing to an enormous enterprise, it became clear that a church congregation simply couldn't and shouldn't be operating them any further and they were spun out. Some of the profits are still sent back to the foundation for community health care grants.
This particular wealth extraction strategy would never have occurred under church leadership.
(disclaimer: I was a member of the church during this period and hold it in very high regard)
Well at some point she needed surgery (at HCA), and about five months later after dealing with 10 < x < 20 bills including one we'd never heard about until collections came knocking she just looked at me and said "Nobody knows what this is going to cost." It really bums me out that a human being working in healthcare here isn't able to even remotely predict the cost of a procedure at the hospital at which they work.
FTFY.
But seriously, how can it possibly be the hospital's fault for doing exactly what the law and market incentives give them every reason to do? There's almost no downward pressure on prices: little competition, no transparent pricing, huge barriers to market entry, and third party payers.
Because they're the ones actually doing it? Because they're run by adults who are fully capable of taking responsibility for their actions?
Worse, it's frequently the same people who argue that corporations are "people" arguing that corporations as a whole shouldn't be held responsible for their actions.
But to use people's lives as leverage to extract absurd amounts of money goes well beyond being immoral, it's just downright evil.
Of course they deserve to be paid. And paid quite nicely, too, considering the education levels needed to work such jobs (Lifeguards, obviously requiring significantly less than doctors)!
But they can be paid nicely while charging reasonable prices. The $164k the hospital charged that man for his heart attack is beyond unreasonable.
Why? Not out of the kindness of their hearts. They know that their name showing up with a bill for $500 for ASA is bad PR, so better to make those common things realistic, and pad their numbers elsewhere (like charging $19,500 for a $1,500 stent)...
Disclaimer: Universal healthcare advocate
I once played dumb to an importer abusing fees, after monthes of bouncing mails to different people babbling the same thing over and over, then dealing with a 'lawyer firm' who behaved the same (basically nobody knew precisely what they were talking about). They suddenly accepted to give me a rebate of NN%. So I received a new bill with 100$ - '80$ promotional deal' = 20$ (normal fee). A very partial grin ensued.
I'm assuming you mean "gospel" and not the 1971 Broadway musical.
Sounds a bit like getting support from Google.
> In a statement, the hospital said this offer was contingent on Calver submitting his application for a discount based on his household finances. Calver disputed that he owes any additional money to St. David’s and said this situation should have been resolved long before now.
I might be misreading, but is this saying that Calver isn't going to accept even the $700 charge, just to make a statement? I obviously side with him but this seems like a crazy stand to take on principle alone.