Hacker News Reader

Comment by umvi | Hacker News Reader

I mean, you are also seeing the extreme cases float to the top because articles like these attract anecdotes. It's hard to tell how widespread the problem is because people who pay a more reasonable amount for stitches don't comment in these kinds of threads. For all we know this only happens .1% of the time

FWIW, I've never had such extreme bills. The largest bill I've received in the last few years was $2000 for my wife's epidural, but I only paid about $400 of it (insurance paid the other $1600)

View on HN

Nearly 100% of people spend some time in a hospital in their lives.

Unless you're claiming that hospitals only gouge some tiny subset of people and are benevolently generous to everyone else, that number is going to be much closer to 100% than 0.1%.

When I lived in the US, I have personally experienced this, even with top-tier insurance--from both ends: I've had insurance decline claims arbitrarily and pass on five-figure costs to me, and I've had hospitals misclaim things. In both cases, I had to spend dozens of hours on the phone to resolve it.

Most people in the US are far less privileged: Their insurance is not as good, and they don't have the luxury of spending dozens of hours on the phone.

It's just a matter of time until you experience this.

> Unless you're claiming that hospitals only gouge some tiny subset of people and are benevolently generous to everyone else, that number is going to be much closer to 100% than 0.1%.

Actually, yes. Doctors and hospitals have relationships. When a hospital is aware that a good referral source referred them a patient, they will try to keep the patient happy to maintain that source of business.

They're very selective about who they try to screw.

Now if you walk in with no referral and no family doctor, then you're their source of profits and the party they'll try to milk.

> Now if you walk in with no referral

You mean like, say, an ER visit?

Though, actually, the one time I've been referred to the ER by a doctor (he called ahead and everything), the billing was still a shitshow. Insurance delayed paying for months while they tried to work out a way to claim it was a pre-existing condition (this was pre-Obamacare), until the hospital gave up and tried to send me directly to collections for upwards of a quarter million dollars.

Given that most private practices (around here, anyway) usually have lucrative hospital affiliations, the incentive to keep doctors happy by keeping patients happy really doesn't exist.

Most people hand it off to insurance and don't look at it twice. My parents have a story of looking at a paid by insurance bill that included $2,000 for two ibuprofen pills. They questioned it, and everyone involved (including the insurance company) said "why do you care, insurance pays for it?"

They don't pay list prices either, and have negotiated something much less. The list prices are basically a fantasy hoping to gouge the unknowing, while the rest of us feel like we got a discount.

It's simple fraud in many cases.

Patient has a 20% copay. The provider bills $100,000. The provider "pays" $80,000. The patient pays $20,000.

Provider then pays a $70k kickback disguised as a discount on other charges, fees for participation in the system, etc. (or never even pays the EOB amount). In fact a total of $30k is paid for the services, and 66% of that comes from the patient.

Insurance gets away paying $10k instead of $24k (80% of $30k). Provider gets the business by being on insurer's provider list. Patient thinks "I'm glad I paid $20k for Insurance. My health-care-spend ended up being $40k instead of $100k." In fact, they'd have been better off without insurance, which would have only cost $30k.

are you claiming most people don't have deductibles and copays? or no in & out of network coverage. if so I'll call BS on this. I've had instances of being billed from out of network provider even though I went to in-network hospital. this is such a common occurrence that John Oliver did an episode on it.

I'm reading what you're saying, and it makes me sad - as if you don't believe that people without insurance are just liars. People are avoiding getting medical treatment because it may financially ruin them. Do please believe them.

Take another look at that chain of bills. I would guess that if the initial bill was for $2000, the hospital only received $800 or so total. So insurance paid half, you paid half, but you think insurance paid for much more when really they just swatted away a fraudulent price.

Yes, very few here have been on the receiving end of a $143k magnitude extortion. The people who have are less likely to be writing HN comments and more likely to be slaving away in the mines of Rura Penthe. But these exceptional stories fit the exact pattern that anybody who has interacted with the healthcare racket has experienced, even though most ultimately dodge the (biggest) bullet.

Reply on news.ycombinator.com