Comment by QuantumGood | Hacker News Reader

Comment by QuantumGood | Hacker News Reader

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Had new insurance and a sore shoulder. Was billed ~$1,400 for a physical therapist to examine it ("evaluation"). No treatment. Very little covered by insurance.

The next day had a chiropractor treat it and shoulder was fine. $25 with coupon. Funny part is, as it was new insurance, I spent over 30 minutes with insurance rep in advance on phone going over options and trying to get an idea of likely costs.

When I had a heart problem and no insurance, we called providers all over town (Minneapolis) to try to get prices in advance. Most would only give estimates over a wide range. Some flat out said it was there policy to not give estimates. Eventually found a cardiologist who worked basically free ($30 plus donation). I bought a Kardio to record my own ECG so I can have more data to improve my communication with cardiologists, who are (understandably) a bit alarmist about what can go wrong and tend to err on the side of (expensive) caution without sufficient data.

Feels like a broken system.

So you have insurance but it doesn't cover stuff when you are actually ill? Does your insurance policy actually spell stuff out so that you can predict what will or won't be covered?

Note: I'm from the UK and find the stories about US healthcare insurance grimly fascinating....

On the phone in advance, was given some hint of what could go wrong.

Basically, it depends on how the provider "codes" the treatment. You can contest the code, i.e. say you should have been billed for something other than what they are calling it. There is apparently a very wide range of things similar visits could be coded as.

Not just health insurance, but healthcare is crazy too.

Spent a total of 36 hours on the phone with the hospital to figure out how much something would cost because I knew I had to pay out of pocket. And they weren't even right when they finally gave me a number.

Had a doctor remove a cotton ball from my ear in the hallway. Charged me 2.4k for that. Didn't have insurance either.

My wife's friend delivered her own baby in the hallway and they still sent her a bill for delivery.

My wife had her gall bladder removed, supposedly the most common surgery. Surgeon charged 25k, hospital charged 65k, anesthesiologist charged 3k, and a doctor that talked to her for 25 seconds charged 1.5k. Insurance and the hospital argued over the bill for almost a year, during which time the hospital kept sending me payment due notices.

No one in this industry has my sympathy.

I couldn’t even get the billing codes for a routine ultrasound. And no one will ever respond to you in writing for anything.

Welcome to the US.

I'm currently fighting insurance because they won't cover a GI tract test without "proof" from another test first.

OK that's understandable. You don't want random people asking for tests all the time, but the Dr already saw me, and gave me meds to fix the issue that would give the insurance company "proof." There's just new complications now.

So I get to wait until everything comes back in full force. Last time I couldn't work for a few weeks, but hey at least they're saving a few hundred at most now....

This is still a better experience than the issues I had with my jaw. The jaw issues are the only pain in my life that was bad enough I blacked out twice from it. But insurance won't cover that because they think it's a dental issue, dental won't cover it because it's the jaw.

The only treatment for the jaw I got was because a jaw specialist lied on the insurance papers. He said he wrote down headpains, not jaw issues. He said he learned that telling insurance companies the truth is not what gets them to cover their clients.

/sidenote that jaw pain is second to none. It runs circles around any migraines (the dark room, no sound kind) I've ever had. Never knew there was such pain before.

The majority of medical related bankruptcies in the USA are from people with insurance.

https://www.thebalance.com/medical-bankruptcy-statistics-415...

The differences in the prices you mentioned are astronomical...

I'm already getting angry here to be charged $50 instead of $25 when the doctor "touches" you during some basic evaluation. But at least they tell you about any massive amounts coming up before any treatment happens.

It's not sane. With insurance, was hospitalized for a heart condition. ~$45,000. Found no problem in testing, so they kept ordering more tests, sending in more cardiologists. Kept hearing "I know you've said this several times already, but please repeat for me...". Each time I repeated the story to a different doctor there was a large bill. Clearly the hospital new how to pad the bill.

I eventually left "against doctor's advice" though there was a doctor there that agreed with me leaving. Pursued lower cost versions of remaining tests recommended on outpatient basis.

The funny part that time was there was a "patient billing advocate" in the hospital, who was magically never available over the three days I was there despite repeated efforts by us each day.

"With insurance, was hospitalized for a heart condition. ~$45,000"

Please tell me you didn't have to pay the ~$45,000 personally?

We had to pay our ~$8,000 deductible, everything above that was covered. We paid by negotiating a one lump sum payment and got 25% off. Had a relative with more cash flow make the payment all at once then paid them in installments. Was told by a doctor later that they only get paid 75% of what they bill by the insurance company, and that considering that, the 25% discount made sense. Tried for a 30% discount but 25% was the best we could do. I pre-negotiated 25%, then had the relative with more experience in negotiating close the deal and try for 30%.

There was a substantial upside. The cardiac event happened early in the year, and everything covered by insurance for the rest of the year was 100% free. We were able to pursue some things we probably wouldn't have otherwise. Simple things like having more cough syrup on hand became a no-brainer as cost of visit and prescription was guaranteed to be $0

> We were able to pursue some things we probably wouldn't have otherwise. Simple things like having more cough syrup on hand became a no-brainer as cost of visit and prescription was guaranteed to be $0

This is one of the big upsides of always free at the point of access healthcare like we have in the UK. Although there is some inefficiency, in practice I beleive it actually lowers the total cost of healthcare as people seek treatment/diagnosis earlier and avoid getting as sick in the first place.

Someone recently pointed out here that in the UK you still have pox parties because the chickenpox vaccine is considered too expensive by NHS. So that's another way to lower costs, of course you now have a 20% possibility of getting shingles and dealing with that pain.

Apparently its not about cost but from a fear (which may be unfounded) of increasing the frequency of shingles:

https://www.theguardian.com/science/occams-corner/2014/may/1...

I wouldn't compare a chiropractor to a physical therapist, but $1400 for a sore shoulder? Was this in the ER?

No. Set up the PT evaluation through regular channels, showed up at scheduled time, etc.

They aren't directly comparable, but I wanted to point out treatment vs. evaluation costs experienced. Chiropractor was evaluation and treatment, PT was evaluation only.

I had to assume there was some kind of error, but contesting didn't help. Probably could have contested harder/smarter, but decided instead not to pay. This provider does not turn non-payers over to collections (no credit impact), and does not refuse later service to non-payers. This was the only item I refused to pay via this provider over years going through them.

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