Hacker News Reader

Comment by Someone1234 | Hacker News Reader

"You didn't check that the second doctor in your surgery, who came in while you were unconscious was in-networking? Well, too bad, you should have done your due diligence more carefully!"

When we had a kid, it was $10K out-of-pocket, and we had a bunch of "out-of-networking" bingo due to mostly lab tests or a doctor out of network at an in-network ER.

Since then kid themselves also had an ambulance ride (seizure), and that too was "out of networking" in spite of being the only ambulance provider available within 15+ minutes.

View on HN

The involuntary treatment by out of network providers and them being able to charge you whatever they feel like definitely needs to be outlawed.

sidebar: In 1991 we birthed a child at home and the absolute total was around $3500.

It was all out of pocket. At the time, insurance would not cover midwives, nevertheless a home birth.

My neighbor did that 3 times. Didn’t work out so hot for the third kid. I would never consider asking if they regret that choice, but I cannot imagine the grief from losing your child in a home birth scenario.

There's a lot of factors that go into the decision making. I don't want to speculate on their birth team - our midwives only accepted the lowest risk mothers.

For our first birth, a hospital would have been a terrible, terrible option. By the time of our 4th birth (10y later, twins), hospital birthing environments had vastly improved. Our OB/GYNs practice was 100% women w/ midwives on staff. The only thing we missed was having a doula.

What you're describing is completely illegal now. Under the Affordable Care Act, which applies nationwide, insurers are required to cover out-of-network emergency care as if it was in-network care, which means your deductible and coinsurance can't be higher than the regular in-network amounts.

Everything I said happened under the ACA. It was "only" $10K because of the ACA's out-of-pocket maximums.

A quick google suggests this is common:

> It's important to understand, however, that the out-of-network emergency room does not have a contract with your insurer, and is not obligated to accept their payment as payment in full. If the insurer pays less than the out-of-network emergency room bills, the emergency room can send you a balance bill for the difference, over and above the deductible and coinsurance amounts you pay.

Balance billing is (far too slowly) moving towards being illegal: https://www.commonwealthfund.org/blog/2019/state-efforts-pro...

You said

>Since then kid themselves also had an ambulance ride (seizure), and that too was "out of networking" in spite of being the only ambulance provider available within 15+ minutes.

That's the illegal part.

If you say so.

The $1,500+ ambulance bill still existed, I still paid it, and my kid wasn't even born until five+ years after the ACA came into force. The insurance company was "nice" enough to let me count it towards my kid's deductible for that year, but I paid every cent.

People will gladly collect money they aren't legally owed. In this case, unless there is more to the story, you shouldn't have paid it.

In normal countries you don't have that kind of criminogenic environment. Also, do stop the victim blaming.

>In normal countries you don't have that kind of criminogenic environment. Also, do stop the victim blaming.

Stop using "victim blaming" as a way to shut down discourse.

In every country in the world people run scams. Universal healthcare would make these particular kinds of scams a lot harder, but I guarantee you, you could still find this kind of anecdotal evidence of criminal behavior relating to healthcare.

I’ve had that experience too. What makes you think it’s illegal?

For emergency treatments, insurance companies are required by the ACA to pay the out of network provider, but charge you as if you are using an in network provider.

It's possible for the out of network provider to then bill separately from your insurance if they charge more than what your insurance pays out of network providers, but there's no way that's what happened here because $1500 after the out of network fee from the insurance company is far too high for an ambulance trip.

I see. Any parts of the law I can cite if I complain? At least in my case and OPs it doesn’t seem that the law is being followed in practice.

As far as I understand, the out of network provider can still come after you for whatever the insurance doesn’t pay them. In the US, you basically provide your healthcare provider with a blank check.

Reply on news.ycombinator.com