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Comment by opportune | Hacker News Reader

I am not a lawyer or financial advisor. But I’ve heard that you can’t be sent to collections if you make a good faith attempt to pay your (medical) bill. Which in practice might mean you just pay $5 while you wait for the itemization

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Our first born came with a $42k bill. Hospital and doctor said we were covered by our insurance pre-auth, but come bill time apparently pre-auth was null and void b/c it was requisite on a negotiation that fell through. Each side had a different story and their representatives acted absolutely helpless.

We were broke at the time we found out about the pregnancy and memories of the first two years of my boy's life are largely dominated by this kafka-esque nightmare that took time and security away from our family life. I refused to pay a cent until what we were told was honored, my thinking being any sort of payment may legitimize it.

Eventually I didn't hear back from the hospital about our latest contestation for two months after confirming their receipt of the documentation (about a four hour process each submission, always new fax numbers, life-wasting hold times to confirm receipt of said documentation, transfers to other agents and departments, then a promise of giving a decision in a few weeks, often just reprinting the last non-descript document they used in the previous round without any real detail). Decided to just do nothing and ignore it as long as I didn't get contacted again and got everything ready to go to court if someone ever decided to pursue it against us again. The documentation I've been holding from the ordeal is 60 pounds of paper.

I still have no idea what the true status is, but it hasn't shown up on credit checks and our boy is now 5 years old.

I could not find anyone in various governmental institutions to even look into the matter and the lawyers I talked to said the outlook of winning was grim and would have cost a lot of money on top of that to even pursue it. Our insurance company [Anthem] posted a $17 billion profit that year. The hospital had the highest gross profit of any hospital in our city and the surrounding area at $80.4 million declared. Both entities make so much money they give away individual debts amounting in the tens of thousands of dollars for pennies (maybe ours included?).

It's an absolutely depraved system and my point is maybe be careful showing good faith to an entity trying to screw you lest it be taken as consent.

You absolutely did the right thing in not paying a cent. There is virtually zero chance you will ever hear another word about it.

The $42k is a fantasy figure which they collect approximately 0% of the time. It's the easiest $42k you ever saved.

Is there any way to get this sort of advice for ordinary people easily? I remember when I was an exchange student to the US from Hong Kong and I got a flu, I thought I'd get it checked out just in case. I went to a clinic and they told me to get into a medical robe for a checkup and I thought wtf. I also remembered about reading all these horror stories. Of course it might not have been that bad since I didn't go through with the checkup but it's very different from what we have in hk and China where the doctor just takes a look at you, blood test at most, and gives you some pills, usually for no more than 40usd max

Why aren’t US citizens queuing up to emigrate?

At this stage, it seems like the US is the “land of the free”, whereby “freedom” is defined as the ability to freely exploit everyone.

Emigration is hard, and emigrating somewhere remotely decent is even harder (because everyone wants to do the same thing as you). I’d also wager that the people who truly need to leave have the least means to do so. Getting into Canada or Western Europe requires at least a college degree, and probably being in a sought-after field. And by that point, you’re probably doing okay in America (for now). I mean, I live comfortably, although even good insurance and a high salary isn’t a guarantee that you’ll be okay. I’ve thought of moving, but the difficulty (logistically and psychology) and the fact that I really am comfortable make it unrealistic at the moment.

I agree, though, the masses are exploited (us included), and it’s troubling.

most are still stuck in the loyalty type mentality buffered by things like patriotism and national anthems and flags for any event with >5 people and a TV camera.

50 years ago people had the same loyalty towards their companies, and look where that got US manufacturing workers. nowadays you'd be nuts to expect to stick with a company for 10 years. get yours and get out: others be damned.

so it shall be with citizenship. as more and more citizens have more and more power to up and leave, or work outside the confines of the US without too much hassle, questions such as "what on earth are we still doing here?" will be asked, at first in whispers (as they are now), later in louder volumes.

where things go from there, anyone knows.

Last time I went to the ER I got an itemized bill in a week for $300 or so.

All medical imaging I've had done has had pricing given up front showing what they where going to bill the insurance company and what the insurance company was going to pay and what I'd have to pay.

My non-emergency visits have a $40 copay up front.

Only the nightmare cases get talked about.

Conjecture is silly when there's good data to be had.

The number one cause of bankruptcy in the United States:

> "medical expenses"[0]

The average amount charged for an ER visit in the United States:

> between 2008 and 2017, the average price of hospital ER visits rose 135 percent, from $393 to $924[1]

The cost of an ambulance ride in the United States:

> $164/mile[2]

And make sure to compound the monetary cost with the cost of people avoiding medical care out of fear and unknowns surrounding the actual monetary cost.

[0] take your pick of any study done by anyone

[1] https://www.beckershospitalreview.com/finance/average-cost-o...

[2] https://www.consumerreports.org/consumerist/164-per-mile-sur...

ER visits at 924 are still far below the stories in this thread of 4-5 digit $ visits for simple issues.

The OOP is still averaging under 300, again, not the horror stories in this thread.

Problems exist, but it seems that only a small % of providers are horribly abusing the system.

(of course a small % across over 300 million people is still a lot of harm!)

USD 900 for an ER visit is a horror story too. Where does someone without savings get that kind of money from? At least it seems difficult for many: https://money.cnn.com/2018/05/22/pf/emergency-expenses-house...

I don't live in the US and I'm not American so perhaps I'm missing some information.

It needs to be fixed, but a $900 average that includes $200 charges for a $25 "medical boot" and charges for a $30 bandaid sounds like it may be not too hard to reduce costs across the entire board.

If the average ER visit was 5K of unknown miscellaneous charges than that would indicate nationwide maliciousness on the part of nearly all hospitals. If only a small # of hospitals are engaging in that level of unfair billing, then they can possibly be investigated one by one.

It is the same thing as "we have thousands servers that are crashing at random multiple times a day" versus "we have a bunch of servers that are low on RAM, and a couple servers that crash 5 times a day."

Neither scenario is good to be in, but it is possible to get a hand on the latter scenario, while in the first scenario a "burn it all down and rewrite" fix might be appropriate.

Which metrics do you measure, optimize for your web services? P90 & P99?

Why would health care be any different?

For one, probably because these stories are the exception? I know a bunch of people will probably tell me I'm wrong and I might be (haven't used the US health system in a 3 or 4 years since I moved out) but for most people their insurance just covers it (or medicade if they're old).

Otherwise most people don't want to leave their friends and family

Note: not defending the horrible system. Only suggesting that most people using their company provided insurance probably don't run into these issues.

I'm a lifelong patient. I currently have great coverage.

I don't know how it's possible, but our healthcare system has been getting worse every year. Even simple stuff like refilling scripts has become Kafka Meets Keystone Kops. The insurer has interjected itself into every single transaction, second guessing everything, adding ever more hoops to jump thru.

It's a wonder that we even bother with doctors any more, since the insurers apparently know better than my doctors.

Things are so bad, I wouldn't even know where to start if anyone wanted to fix things.

Better to just start over.

Company provided insurance, only cost us $5k to have a healthy pregnancy followed by a healthy baby, with no special circumstances. This was the usual “negotiated” cost. Why not print $2mil for a yearly wellness check while you’re at it, and then give a generous 1.9mil discount? The whole system is absolutely positively bonkers. How much of my premium is going to professional negotiators for insurance, and how much of my hospital costs are going to professional negotiators for hospitals?

Not much. Your premium is going towards paying for the $1M NICU cases where it takes extreme interventions and the $1M/month hemophilia patients. Even a population of a small state like Iowa can have problems distributing costs like that.

https://www.desmoinesregister.com/story/news/health/2017/05/...

I think distributing the costs is entirely reasonable; warranted, even. That is, after all, why insurance works at all. Distributing the cost by inflating receipts is, no matter how altruistic or “necessary” you may think it to be, a fraud.

Because most of these stories are extremes. All my friends' pregnancies and major surgeries came with some hefty "residual" bills, but all got negotiated down or tossed. If you stand up to them they'll back off. About 80-90% of America has insurance that is "ok" and will keep you from going bankrupt. It's not as bad overall (big picture) as the anecdotes portray. Don't forget there are 340 million people in the USA (1% is still 3.4 million people, plenty of room there for stories to arise). It still really sucks and we need price controls and public option for insurance though. Also fear of the unknown, leaving your family behind, other countries in general don't like Americans unless you bring a few million dollars with you, other countries seem to have a very high barrier to foreigners working there, etc get in the way.

At least what we know is that currently the flow of migration is reversed with a lot of European countries. Many countries like all the northern countries, Netherlands, Switzerland, or even Spain have more Americans moving than their own citizen settling in the US.

Seriously thinking about it.

I am also a British citizen, so I'm at least waiting to see how this whole Brexit thing shakes out.

Australia has the largest British ex pat population: https://en.wikipedia.org/wiki/British_diaspora#Institute_for...

If you're considering somewhere in the EU other than Britain or Ireland, you should probably aim to be registered as resident before 31 October.

You'll probably get a bill in a few years for 10% of the original amount from a bill collector the debt got sold to. Don't pay that either. They should have made sure your insurance covered it, so the onus is on them.

Insurance companies negotiate a lot of this stuff away. The poster needs to call them first, see if they can arrange a $5 payment without addition interest while the itemized bill comes in (honestly, there is legal ground here for not even being willing to honor any of the bill with itemization).

Get on the phone, try to keep cool, but realize you're probably going to yell at some poor customer service rep at some point. Apologize, keep going and get the full bill before you agree to pay anything. Then you gotta do the same thing with the full bill on ever bullshit charge, over and over again.

Honestly, how the fuck can they admit you and treat you and then bill you without telling you what the prices are up front? That's fucking madness right there. Imagine having to agree to having car or bicycle service without an estimate? Imagine the total cost being $2000 over the estimate? Would people pay? Of course not; it's worth it at that point to call a lawyer.

The trouble is that in an emergency or urgent situation, you can’t really shop around for service. “I’m having a heart attack, but can we try the hospital in the next town over? Their cardiologist is cheaper.” Bike service is a leisurely afternoon; emergency medical care is not.

It shouldn’t cost that much in the first place. You shouldn’t need to shop around for health care, and you shouldn’t be bankrupted by an emergency. Why people aren’t marching through the streets right now is beyond me.

At least one hospital was pretty aggressive:

https://www.washingtonpost.com/health/uva-has-ruined-us-heal...

That would "acknowledge the debt" or something like that from what I understand?

From what I understand it, it doesn’t mean you acknowledge that the entire bill is for the correct amount. Also if you know you’re going to have to pay at least $5 out of pocket anyway you’re not really losing money. But again IANAL I’m just parroting advice I read on Reddit one time

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