Hacker News Reader

Comment by alberth | Hacker News Reader

I’m confused, so what exactly do the hospitals want to gain from this “medical” credit score?

If the hospitals simply want to gain insight on your ability to pay your medical bills, wouldn’t your “normal” credit score be able to provide that insight.

What’s different between your “medical” credit score and your normal credit score?

Edit: Additionally, there are laws in place in the US that state in emergent situations, no hospital (public or private) can deny care - regardless if you can pay or not. So the article title might be a bit sensationalized.

View on HN

I'm with you, not paying medical bills affects your credit score the same way as any other bill. To me, it seems like it's just another service for the credit unions to make money on, while giving private hospitals some legal protection.

Really, it's disgusting.

s/credit unions/credit reporting agencies/

credit unions are one of the few pro-consumer entities in the financial world, it would be a shame to smear them

I will add credit unions are chartered banks...but unlike "banks" they are not owned by shareholders, they are non-profits made up of the members (account holders).

Ideally in 2008 all the "banks" should have gone bankrupt and the vacuum should have been filled with credit unions, instead lawmakers gave the banks $2T as a reward for ruining the US economy so they could float their own debts instead of declaring bankruptcy and enough so they could buy up their competitors to further consolidate the marketplace.

It is not exactly the same. The bill cannot go into collections for 180 days. This is different from regular debt.

180 days is generally how long it takes their system to adjust the charges and send you a semi-fraudulent bill instead of the fully-fraudulent one.

Medical debt is regarded less harshly in FICO 9. I am not sure how widespread the use of FICO 9 is currently among credit bureaus but it is the latest standard.

It is possible that in non-emergency situations, the vast majority of situations, a hospital may deny or change the quality of care based off of your likelihood of paying it off. No one knows the difference between a "medical" credit score and a normal credit score, but we do know that this special, secret credit score is being used to calculate patient treatment.

Wouldn’t the easier solution be to not accept patients without insurance (and low co-pays).

And given that it’s now a US requirement to have medical insurance, I’m still struggling to understand what this medical credit score is accomplishing.

There are laws against denial of service.

Only in life-threatening circumstances.

Which is kind of funny: all medical problems are life threatening. The only differentiator is how long it'll take them to kill you.

That's patently not true. Acne is a medical problem faced by a substantial portion of the population at one time or another. In all but the rarest of cases it is not life threatening.

From the acne Wikipedia page:

"There is good evidence to support the idea that acne and associated scarring negatively affect a person's psychological state, worsen mood, lower self-esteem, and are associated with a higher risk of anxiety disorders, depression, and suicidal thoughts."[1]

While Acne probably won't kill you, it certainly won't make you happier and could contribute to suicide if left untreated. We are lucky that acne meds are cheap, but there is nothing stopping those companies from shooting up their prices tomorrow.

[1] https://en.wikipedia.org/wiki/Acne#Prognosis

In that case depression is the life-threatening ailment, not the acne. Just like pneumonia is the reason you go to the ER, not a common cold on the off-chance it might later become pneumonia.

Also by the way, the requirement to provide care to any walk-in patient only applies to ER's, and only until they have stabilized the patient.

Well, the requirement is more specific: the hospital must treat you if you are in immediate danger of dying. They only have to treat to enough to stabilize you, though, then their legal responsibility is complete.

I agree with the OP in a stronger spirit. It’s in society’s own best interest to ensure a basic level of quality of life to its members. There are many illnesses out there which can severely, negatively affect a persons life but otherwise aren’t always treated because of mitigating factors. Sleep apnea is a good example. Many can get by without treatment, but eventually complications from it or side effects of it can lead to chronic fatigue/reduced productivity at work, and even lead to death. Back pain can do similar. It’s not life threatening but can lead to reduced work productivity which could contribute to being terminated.

Yes, I agree as well. I was just describing how things are, not how they should be.

Medical insurance only covers treatment from specific medical practitioners, of which an entire hospital may contain a wide array of medical practitioners under and also not under any specific patient's insurance company. Having a routine surgery from a surgeon that is covered can still rack up an intense medical bill from an anesthesiologist who is not covered.

Similarly, if the insurance company for any reason disputes a hospital claim for any reason, up to and including disagreeing with the hospital that the issued treatment was appropriate in lieu of a cheaper treatment, the hospital goes to the patient to foot the bill.

So it is entirely possible to be fully insured and still be forced into unpayable medical debt through factors completely outside of one's control.

> So it is entirely possible to be fully insured and still be forced into unpayable medical debt through factors completely outside of one's control.

It's frustrating to me that this point is very often overlooked in the discussions about health insurance in the US. A lot of people who go bankrupt over medical bills are fully insured and suffer for reasons entirely beyond their control like the hospital an ambulance decides to route them to when they're unconscious.

Which sometimes makes me wonder, why pay for insurance at all? Sure sounds like a racket, "pay us and you may get into medical debt, don't pay us and we'll make sure that you do"

Precisely because "pay us and you may get into medical debt, don't pay us and we'll make sure that you do".

This depends on the state. Many states have passed surprise billing laws, and limit what an out of network provider can charge

It's a requirement to have medical insurance, but the cheaper qualifying plans have enormous deductibles.

A Bronze family plan will typically have a $13k deductible. You pay that entire amount out of pocket before insurance kicks in, and it resets annually... so if you're in the hospital December 31 through Jan 1, you might be on the hook for $26k.

There's also nightmare scenarios where the hospital is in-network, but the doctor isn't. https://www.reuters.com/article/us-health-insurance-surprise...

Also the deductible fiscal year conveniently restarts halfway through flu season.

The high deductible plans were originally for healthy young individuals with an health savings account to pay for the occasional deductible. These plans could be used as tax free investments if you got lucky. These days families end up getting the high deductible plans because that is all they can afford. And they do it without savings to back it up.

This is incomplete. A bronze family plan will typically have a deductible of $6k for an individual, and 13k for the family, but it also has an out of pocket max of slightly over that, so once you meet the deductible that is all you pay. Also almost all bronze plans cover the first 3 doctor visits with a normal copay, and any preventive care has no copay. Gold and above plans typically do not have a deductible, and the out of pocket max is lower.

Many states have surprise billing laws to limit what bills you can receive from out of network providers.

>And given that it’s now a US requirement to have medical insurance

It became a "requirement" in 2014 with Obamacare, but since the repeal of the individual mandate in 2019, there is no financial punishment (except well, the increased possibility of medical bankruptcy) for not having insurance:

https://www.kff.org/health-costs/issue-brief/how-repeal-of-t...

I'm glad the requirement is gone. I had trouble affording insurance under the marketplace plans when I returned to the US:

https://battlepenguin.com/politics/returning-to-america-and-...

Nit pick, but I think the word you two are looking for is “emergency” rather than “emergent”.

"Emergent" is the term used in the trade. Webster has this to say:

> “Emergent” properly means “emerging” and normally refers to events that are just beginning—barely noticeable rather than catastrophic. “Emergency” is an adjective as well as a noun, so rather than writing “emergent care,” use the homely “emergency care.”

Since you're nit picking already and because it's a "today I learned" opportunity, parent's usage fits one of the definitions of emergent, the first one here: https://www.merriam-webster.com/dictionary/emergent.

TIL indeed. Must be industry jargon or trade usage as another reply put it. As a lay person I’ve only ever heard it referred to as “emergency services”.

I have corrected this, despite some discussion back and forth, for clarity.

Standard Credit scores are more lenient for medical debt. It takes 6 months for unpaid debt to show up and fully removed if paid in full even after it is sent to collections.

I believe medical debt is no longer allowed on credit reports now. Maybe this is to get around that?

"Specifically, the NCAP prohibits adding medical debt to credit reports until after 180 days from the time the account was reported to the credit reporting agency. It also mandates the removal of previously reported medical collections that have been or are being paid by insurance." [1]

Medical debt can still be added to your credit report.

[1] https://www.creditkarma.com/advice/i/how-to-remove-medical-c...

They might want people to be afraid that if they don't pay their bills, they might die. Since the threat of debtors' prison is no longer viable, I guess.

Moves like this erode my opposition to nationalizing the entire US health-care sector. If they're going to cartelize or confederate, patients--which is to say everyone in the country that lives and breathes--will also want a seat at the table.

From a more generous perspective, this may be a tool for price discrimination. Hospitals will charge based on what they think the patient can pay, rather than the actual costs of providing the care. When you receive care, you will be billed for a number that is calculated to make you sigh, flinch, or wince, but not call a bankruptcy lawyer.

This is a symptom of illness in the system, and leaving it untreated seems like a bad idea.

I bet 'Likely to be litigious' score is part of that Score. Physicians and hospitals would kill to see such a score before they start treating new patients

> Edit: Additionally, there are laws in place in the US that state in emergent situations, no hospital (public or private) can deny care - regardless if you can pay or not. So the article title might be a bit sensationalized.

This is true, but many life-saving treatments (such as chemo or radiation treatment for cancer) are not "emergency" treatments, despite being necessary and somewhat urgent.

The legal obligation hospitals have is that they must treat you if you are have a life-threatening emergency happening. That treatment can be the minimal amount needed to stabilize you so that you aren't at immediate risk of death. There is no obligation to treat you beyond that, nor to engage in follow-up care.

Yes, that is the current legal obligation. This is not enough, and important life-sustaining healthcare (such as cancer treatment) should be available to everyone, even if it is not an immediate emergency.

I agree, but we're a long way away from that in the US.

In Switzerland private hospitals will calculate the possibility of success in your case and if it is too low you will not be accepted, because they want to keep their success rates high... Maybe such "Medical Credit Scores" could be used for the same reasons...

I believe medical bills over $100 no longer count against your credit score so of course that created an opportunity to break them out and market them specifically

I think you’re viewing the problem backwards. It’s not that they intend to send out a standard bill and know in advance who can pay. It’s that they intend to send out bills scaled to people’s ability to pay.

It’s probably more profitable for them to send a small bill to a poor person than a large bill that is never collected. It’s definitely more profitable to throw the most ludicrous bill at those who can and will pay whatever cost is sent at them. You can also adjust the kinds of treatments given according to likelihood of profit.

I wouldn’t be surprised if the latter case is illegal (or happening or not). I’m pretty sure the former case is perfectly legal, though symptomatic of a bigger problem.

Reply on news.ycombinator.com