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Comment by excerionsforte | Hacker News Reader

Low cost home testing kits can go beyond SARS-COV2 and track other diseases all from the safety of your home. Why go to the hospital where you could possibly be infected by other people with infectious diseases or infect the people around you.

Personally, if it is low cost enough that I don't need to use health insurance then I am all for it. Health insurance is good enough until surprise they don't want to cover you or you get surprise bills in the mail from the hospital.

Gates Foundation is absolutely forward thinking. I like it a lot.

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> Health insurance is good enough until surprise they don't want to cover you or you get surprise bills in the mail from the hospital.

Constantly amazed this can be a thing in a first world country. Can this actually happen?

Yes

All the damn time. It’s so infuriating.

Yeah it's pretty common. There's a reason health insurance is such a big political discussion in the US

A close friend of mine's wife paid their health insurance for decades, without fail. Their employer changed the insurance provider without notification, but somehow they continued paying the wrong provider. She recently got breast cancer, and now the new provider is denying all claims on the basis that she was paying the wrong provider.

They are basically screwed now after maintaining a non-deliquent relationship with their healthcare provider for longer than I've been alive. If this is not emblematic of what's wrong with our healthcare... IDK what is.

My friend paid his health insurance for years. Got diagnosed with cancer (leukemia). Hospital said treatment would cost $750k. Insurance told him to go fuck himself and isn't covering anything.

Do you know what the treatment option(s) were? That seems extremely expensive even for cancer. Makes me wonder what my family plan's maximums are.

I do not. They managed to raise about $80k through GoFundMe, and he just found a donor after months of looking. Assuming he will be in debt for the rest of his life, if he lives.

Doesn’t seem unrealistic for a list price. List price for a standard baby delivery and 3 day recovery around here can be up to ~$80k. Of course, the real insurance contracted price is $10k. The list prices are completely absurd, and it’s even more absurd that hospitals try to collect that clearly fictional amount from patients without good coverage.

After ACA there are no lifetime maximums. If it’s an FDA approved treatment which he is eligible for (e.g. there are not other first line treatments which should be tried first) then AFAIK an insurance company cannot simply refuse to pay.

Another option is to move to a Medicare expansion state and stop working, which will allow you to immediately qualify for free health care with generally some of the best coverage you can get.

Insurance companies are free to not cover an FDA approved product. CVS publishes a list every year, although they tend to either be the branded drug when a generic is available or a drug where there are as effective, but cheaper products are available.

It’s a cost versus benefit analysis and no different than what you see in single payer systems.

I will say from experience that oncology is one therapeutic area where payers wield much less control. Insurers don't like bad press and denying cancer drugs is a great way to end up in the NY Times. That said, if a drug is regarded as "experimental" (either the FDA hasn't approved it for that type of cancer OR there is limited data to suggest it works) they will say "no".

https://www.caremark.com/portal/asset/Formulary_Exclusion_Dr...

Insurance companies certainly can have formularies. I noticed that there aren't any drugs on the excluded list that don't have alternatives listed.

When we change insurance plans my kids have to change the brand name of insulin they get. Humolog, Admelog, etc. But the insurance company can't decide that they won't pay for fast-acting and slow-acting insulin. And if there is a medical reason a doctor will sign off on that indicates a specific brand is required, I believe that you can generally get even excluded medicines covered.

Can insurance companies refuse to cover an FDA approved drug that doesn't have a reasonable substitute? OP discussed treatment for leukemia. An ACA plan should cover approved treatments for leukemia, but it might not cover, e.g. the latest CAR-T treatment if it's still in Phase 3. You would need to get into the study, in which case treatment would be free.

Just to be clear, you mean that the insurance company is not allowed to set a maximum lifetime (or annual, for that matter) limit beyond which they will stop paying expenses, correct? P

Under an ACA approved plan, that is correct.

> somehow they continued paying the wrong provider

How does it happen that the wrong (old) provider still accepts money if they no longer cover you? Can this be used as a legal argument that the old provider is on the hook for coverage since they continued taking the money?

"After review, it seems you are no longer eligible for our services. Have a refund"

Interesting. Is a defense mechanism to this then to use the healthcare at least once every period you're comfortable with? I have Kaiser Platinum and looks like I'm about to start requesting monthly tests on things.

Co-pay is about $10, so for $10 a month I can guarantee my healthcare is working.

Not only does it happen, it's more likely than not.

Not only can happen, this is often what happens by default.

You go to a doctor, then the doctor and the insurance have several months of ping pong during which you get about half a ream of "This is not a bill" documents that show a different set of things with different dollar amounts every other cycle, and then eventually you get an actual bill for the largest amount.

If it's wrong, you can spend another year fighting them to fix the billing codes.

It's a total shit show.

combine that with frequently incompetent medical coding, and your insurence ends up not covering stuff they would otherwise cover 100%. my wife is on 3-way phone calls between the billing dept and insurance every month fighting incorrect bills from 6 months ago that did not arrive until 3 months later. she is now basically a better medical coder than the provider. it's a fucking circus designed to make patients pay through attrition alone - it eats away at your morale and free time.

It happens all the time here; it's ridiculous.

At my company's last benefits meeting (where they go over the yearly changes to our insurance coverage) a coworker described a situation where they had a surgery at an in network (accepted by our insurance) hospital, with in network surgeons and nurses, but was assigned an out of network anesthesiologist without his knowledge, and later got a giant bill for it (well over $1000, IIRC).

Even when a person tries to follow all the rules, they find a way to screw you.

I'd like to see a legal limit to this out-of-network billing. If you limit them to the medicare reimbursement rate, I think this would stop happening.

Banning networks would be less drastic than setting out of network prices to Medicare.

Maybe before a surgery, gather all of the hospital staff who are going to attend, and record a video while saying "I do not consent to working with anyone from out of network. If you are an out of network physician, I do not consent to be your patient." That ought to be interesting in court if they bill you. Really, the onus of responsibility is between your insurance company and the hospital (i.e. paying and billing party). If they fail, it needs to be something resolved between them. Because that's their fucking job.

You clearly haven't dealt with these guys. The hospital can charge whatever it feels like and the insurance pays whatever it feels like. And the patient sits in the middle and has to figure it out.

I have dealt with them, once, and I got the pokey end of the stick. I honestly don't know what would work, but I think operating on someone who has specified that they don't consent is kinda the definition of criminal; I think Mayhem would be the official charge.

You would think that repeatedly charging people for procedures that never have been performed would also be viewed as criminal but they get away with it all the time.

Look up a legal concept called quantum meruit - you can be on the hook for things you didn't consent, on the grounds that your needs were not foreseeable and a reasonable person would have consented if they were conscious at the time. I am of course over-simplifying but HN isn't the place for a long discourse on medical litigation strategies.

I am familiar with the concept (still think it's insane though; I value my freedom of choice more than my well being). I came up with this idea because it records me expressly refusing consent to the doctors if they are not in network. If they still operate, and are not in network, I'll see them in court with video evidence of malpractice and mayhem. I'm sure in the US legal system this has a low probability of success, but hey, maybe I can crucify them on the news for it.

In my family we had a situation like this (slightly different issue: whether or not a certain procedure was covered). The hospital had the insurance company RECORDED ON A PHONE CALL stating the procedure was covered. They still refused to pay. Also interesting that the hospital apparently routinely records their calls to insurance companies..

And no, the onus isn't on the hospital. They want their pound of flesh even though they assumed you the procedure was covered on the basis of their staff calling your insurance company.

"Even when a person tries to follow all the rules, they find a way to screw you."

The whole hospital seems designed to set a bunch of elaborate traps and all of these traps will cost you a lot of money. Whatever I hear there is almost no way to protect yourself besides being lucky.

A lot of the practical billing annoyances would go away if the individual practitioners had to get paid by the hospital instead of directly by the patient’s insurance, like subcontractors in any other industry. As a patient, you should be dealing financially with no more than 2 parties: your insurance provider and the hospital.

Very much agree. This is something you learn after a hospital visit or two, and it makes no sense.

Doubly so since, as a patient undergoing examination/treatment, you have zero chance of sussing out who is who, what organization they work for, how their billing works, etc.

All you know is someone came into the room to run a test or otherwise interact with you. It's not like you can interrogate them and then refuse their services -- among other things, they don't even know how their financial org is going to bill you.

My mom had a very mild form of breast cancer 10 years ago, caught in the earliest stages and hasn’t reappeared since. Last year, her oncologist had to get creative with billing codes, because the insurance company changed mom’s coverage so that yearly screening was no longer “preventative“, and thus not covered. No warning, just a huge bill when she went to pay the copay and leave. The insurance is through her job as a teacher in a large county, and is generally a very comprehensive plan. It would be a gold plan of some sort through an Obamacare exchange. Never underestimate the callousness of the American health system.

This happens all the time. A colonoscopy is covered, but if some random not quite perfect thing is found that they snip out just to be on the safe side, then colonoscopies are never again covered.

Yes it happens in many countries. For example in UK someone mentioned they have Phenylketonuria and their NHS will not cover a medicine Kuvan that would improves their quality of life by allowing them to consume a reasonable amount of protein.

Most likely that was based on a cost benefit analysis involving QALY. Which is logically a reasonable way to figure out how to spend Healthcare dollars. The US system is not.

The NHS negotiates prices directly with drug companies. Usually this situation happens if a drug company refuses to offer a reasonable price. Yes this sucks for anybody who depends on such a drug, but there is no alternative.

This is misleading at best. The NHS Comissioning Board has commissioned Sapropterin for use. However, due to its extraordinarily high costs and limited efficacy compared to maintaining a restricted diet, it is only prescribed in scenarios where there is an urgent clinical need for treatments like Sapropterin.

The NHS Commissioning Board's report on Tetrahydrobiopterin/Sapropterin/Kuvan is here: https://www.england.nhs.uk/wp-content/uploads/2013/04/e12-p-...

Not only can it happen, it happens regularly to almost everyone.

Almost everyone I know has a nightmare healthcare story. We have the worst healthcare of a first world country. Many folks who have employer provided healthcare from top tier tech companies are kinda happy but anyone who is below the 50th percentile is living on the edge and playing a gamble.

I’m a solopreneur and we’ve decided to go without health insurance. The ridiculous premiums + super high deductibles mean even if you were to go to the doctor, you’re still paying full cost.

The gamble is you want to avoid any catastrophic visits which would cost 20k+ to offset the insurance deductible + premiums.

Compared to Australia, US healthcare system would be considered a joke.

We're already out of pocket about US$1000 this year with basic check ups, lab tests, and one allergy test (more to come) for my SO. That's with one of the best employer provided healthcare benefits I've ever had that has about $400 a month in premiums.

If I need a sleep study or further surgery as already recommended then we are looking at $4-5k for that alone not including followup, medications, supplies, or other appointments.

Without the ACA I might be dead today due to costs and availability like if I was denied insurance based on pre-existing conditions and could not afford medical care I needed over the last 5-8 years plus mental health care. My parents paid about $22k out of pocket for a surgery I needed during that time (and on their insurance).

I'd have about $45-50k in the bank if my healthcare over the past decade was 100% covered. That is about 10x my current retirement savings or could be a down payment on a house. The USA is not representative of first world countries or at least should not be directly compared to them when it comes to health care.

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