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Comment by setr | Hacker News Reader

There's a strange relationship where the bill provided to you is not actually expected to be paid as-such when given to the insurance company -- they will generally challenge the bill, and through a court, it will be negotiated to something more sane -- and this bill will finally be paid out.

So a doctor can charge you 10k, but the insurance company itself will only end up paying 2k to cover it (and you pay your deductible).

So the charged price is entirely divorced from reality.

You get fucked when you don't have insurance, because you can't participate in this process

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Your general point about the bill being divorced from the reality of what the hospital expects to be paid is true but the idea that this usually involves the court system is not.

In most but not all cases the insurance companies pay less because they have pre-negotiated rates with the hospital and not due to challenging a bill. Even when parts of a bill are challenged by an insurance company the issue is more frequently resolved without involving the courts.

I have a chronic condition which requires monthly visits to a doctor. For every visit the doctor bills the insurance company $380 and the testing lab bills $75. For every visit the insurance company reduces the charges paid to $90.60 and $14 which are the rates they have pre-negotiated with the doctor and lab for these particular services. No court or case by case negotiation required.

>You get fucked when you don't have insurance, because you can't participate in this process

This is not accurate. Cash payers just have to go through the administrative part themselves, cobbling together charity and self-negotiation, eventually landing on a payment plan that doesn't get reported to credit agencies.

So the medical industry is based on intentionally giving ridiculous bills that no one can pay and waiting for people to haggle them down in hopes of not having their finances crushed?

Yes, this is accurate. There is no expectation, from anyone, that a person with a $1.1m medical bill will pay that. There's a specific group of people called Medical Bill Advocates that help people navigate the medical billing system.

As well, people don't really go bankrupt from medical costs that often. Hospitalizations cause about 4% of bankruptcies among nonelderly adults. Among uninsured, this rate is about 6%. They mostly go bankrupt because they lose their jobs and income [0].

[0]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5865642/

Could you go to court as a private person to negotiate the bill down?

As a private person you don't need to go to court to negotiate. Just call the hospital, threaten not to pay, and offer a lower amount. Ask to speak to a manager. Every hospital has different policies on collections, and exceptions are always possible.

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