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Comment by opencl | Hacker News Reader

There is a whole industry of "medical billing advocates" you can pay to find what is likely thousands if not tens of thousands of dollars of completely made up charges on any given US hospital bill and "negotiate" them away. You don't necessarily need press coverage though it obviously helps.

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?

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Relevant blog post: https://meaningness.com/metablog/post-apocalyptic-health-car...

> 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.

Billing "mistakes" seem to be standard practice.

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.

Yea, but to hire a medical billing advocate, you need: 1) knowledge/information that they exist and that hospital bills are BS, and 2) money to pay the advocate AND the reduced bill. If the final bill is $800 and the advocate gets a cut of the savings, how many people in dire straights are likely to be able to afford that? Keep in mind, most Americans don't have 1k in savings, living pay check to pay check because they have no choice. Facing a 100k bill, people are more likely to wait for the collector to show up and then declare bankruptcy, facing damage to their already poor credit, garnishment of already subsistence wages, etc..

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.

sounds like an opportunity....

For what? Lay out a business plan in this area for me that doesn't take money from the worst off.

If you make money off them but save them more money than you costs, it is still towards their benefit. The only problem occurs when you start working with the hospital to create even more arcane bills that you get into immoral territory.

That's exactly the circumstance I outlined previously. This plan has you taking the debts of somebody who cannot afford to pay, reducing them to something above the actual cost, then asking them to pay the higher amount. You are making money from the least able to pay and profiting from a system driving people into bankruptcy. I cannot imagine starting such a company without serious empathy issues.

I don't have all the answers, but here's where i'd start:

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.

I had a hernia surgery shortly after a plan change. The hospital believed insurance wouldn't cover, so they discussed cash pricing with me of around 7k. The insurance ended up covering their portion with me paying about 2k out of pocket.

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..

A key element here is do not pay immediately. Once you pay, they stop working on the problem entirely.

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.

Millions of people no doubt.

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