The staggering cost of surviving heart disease in the USA | Hacker News Reader

The staggering cost of surviving heart disease in the USA

kingsley.sh

23 pointskingsloi21 comments

Off-topic but relevant to the article. I've never heard anyone refer to Gary Indiana as "beautiful"

Thought the same. Can only imagine the writer is being tongue-in-cheek or aspirational.

I mean, the city isn’t the best, but the surrounding area is beautiful, I get to see the Chicago skyline from my living room, from 50 miles away. I walk(ed) my dog on the beach every day, I think I’ve mentioned in another HN post, but those days where it’s quiet, and the lake is still, are some of the most peaceful moments of my life.

Thank you for sharing. Just because the authorization was not taken, insurance denies the claim for all 147 days!! Just too painful to navigate these processes.

Thank you. I’m sure it’s just a snag, but why not just investigate before sending me anything, if I may not actually owe it, why stress me out saying that I do?

Genuine question; what happens at this point? That's a stupid amount of money that many people will never be in a position to pay off. If they can't get it changed to something they can actually afford, is it simply a case of declare bankruptcy? Lose every asset you own, but then you're at zero rather than at minus a million.

Yes. You either declare Chapter 7 and get to keep what debtor protections allow you to keep, which varies wildly by state; Texas and Florida have very strong protections for example. Indiana and Illinois debtor protections are...less robust.

It’s gotten much rarer, but some health providers and systems will forgive some or all of the debt depending on your financial position and public relations.

So, that’s where I am now, I’ve questioned the bill, and I’m waiting for a return call from both the hospital, and my insurance. People have suggested getting divorced, or selling my house. One ends my immigration here, so bankruptcy/selling/losing my house is a possibility.

I’ve heard people say to only pay the hospital $50/month as they can’t do anything, but if that’s the case, will my hospital bills outlive my daughter? I’m too afraid to ask. What a depressing thought.

We’re in the process of applying for medicaid as her disability automatically qualifies her for certain stuff, but I genuinely have no idea what I am doing, like getting thrown in at the deep end. Everything is an acronyms, and Indiana and Illinois are like foreign countries, things exist in IL that don’t exist in IN, or named X in IL and Y, in IN.

You should consider seeking the advice of an attorney who specializes in working with debtors.

Aye, lawyer up.

Especially since in some cases in some places, if you start doing things now to try to limit the effects of that bankruptcy, it can be seen as trying to hide assets or such like.

Lawyer up. Medical debt specialist. Get a professional to look at it and tell you how screwed you are and what to do now to limit to lifetime effects. You are helpless against the teams of professionals with decades' of experience on the other side. This is no time to pussyfoot around or try to do things yourself. You know this to be true.

Go pro, go early.

That clock is ticking. What options do you have that will expire in a week? You don't know, but your lawyer will.

I wish I didn't have to lawyer up, I wish I could be permanently lawyered down youtu.be/PtnLAUcqVBc

I appreciate the advice. I'll do some digging, ping some emails/make some calls and see what the deal is.

>Nevertheless, when you compare the UK NHS to the system we have in the USA, the benefits - especially for those of lower means - far outweigh the downsides.

Alfie Evans died. Sterling Raspe is alive. The UK has its own version of "staggering cost" in healthcare.

Going down the route of cherry-picking cases where someone could have lived had they only received medical care, I think the US isn't going to come out great.

Especially given that you've picked an extreme and uncommon case with no assurance whatsoever that the patient would have lived given any treatment anywhere, and which could have killed him purely by being transported; how about if we pick something far more common, like diabetics dying simply because they can't afford insulin?

The Alfie Evans case had nothing to do with cost. It was entirely about what was in his best interest. He had a catastrophic and untreatable, progressive, neurodegenerative condition. Death was the only outcome. The argument was whether he'd have a painless death in hospital, or if he'd be made to suffer by transferring him to different hospitals or outside the UK.

Some of the court documents are freely available online.

https://www.bailii.org/ew/cases/EWHC/Fam/2018/308.html

https://www.bailii.org/ew/cases/EWCA/Civ/2018/550.html

https://www.bailii.org/ew/cases/EWCA/Civ/2018/805.html

https://www.bailii.org/ew/cases/EWHC/Fam/2018/818.html

https://www.bailii.org/ew/cases/EWHC/Fam/2018/953.html

https://www.bailii.org/ew/cases/EWCA/Civ/2018/984.html

I'm glad you posted this. I was curious at what point the NHS would decide that a newborn was beyond saving. I know there are cost vs years-of-life calculations at the other end of life, but this case sets an extremely high bar for extraordinary efforts expended to a baby.

No, the argument was whether his parents would be in charge of his treatment, or if the state health system could confiscate their kid.

Maybe read the court documents before commenting further.

"Confiscate"? He was human. He had human rights. He wasn't the property of his parents. He wasn't an object that they could control.

I fail to see the connection between a child with an untreatable neurodegenerative disorder who was cared for by the NHS free of charge until treatment was ruled as futile due to "total destruction of white matter in the brain" and a child with a number of completely treatable issues whose parents cannot afford to fund their treatment.

Given the name, I'm assuming OP is the blogger. Please follow up on this, seeing as it was only posted a few days ago. You almost certainly don't really owe that. This type of thing happened to me many times years back when I was going through repeated spine surgeries and years of rehab and therapy. It felt like a nightmare seeing some ridiculous huge number pop up that my insurance refused to pay, but there was never a time I actually had to pay that. Medical providers effectively just send arbitrarily large numbers to insurers knowing they're never going to see much of it, but they also know they're not getting it from the customers if insurance denies it, either. Maybe a hospital is different, but there is no benefit to them in forcing you to go through a bankruptcy and then not getting paid anyway. Sometimes, these charges will just go away on their own and there is nothing you need to do. Sometimes, you'll have to go through a ton of hassle. But 1) they know damn well you can't pay two and a half million dollars, and 2) that isn't the actual cost to them anyway.

This last point is confusing as hell and was one of the all-time great WTF moments of my life when I finally asked the office manager at my spine surgeon what the deal was with these absurd prices they were charging the insurance company. At one point, some neurologist I'd never even met did a two-minute consult while I was under anesthesia via video and charged the insurance $14,000 for that, which they did not pay, but neither did I. Whoever that was got along fine losing two minutes of his life without being compensated for it. When the office manager explained to me how they do billing, he told me the providers and insurance have no upfront agreement regarding what the prices of each procedure are going to be. The provider just knows there is some limit to what the insurance will pay, but not what it is. So instead of even trying to set some sane price, they just bill an arbitrary very large number hoping it is higher than the limit and they'll get whatever the limit actually is, and when they don't, the times they are overcompensated will cover for the all the times they are undercompensated. It's like metainsurance for the providers themselves, except they're also providing the insurance to themselves as a sort of ad-hoc forced savings mechanism.

Billing is totally messed up and the US healthcare is maybe the worst example of a jacked up attempt at combining some semblance of a market with centralized regulation the world has ever seen. But you almost certainly will never have to pay this money. There was never a single year I actually ended up paying more than my out of pocket max. And all those credit dings for the $120 bill that was one of 60 and slipped through the cracks just because it's impossible to track all the mail you're getting feels like a bigger deal than it really is. Don't fret over your FICO score. It's not what it used to be. In my experience, only consumer lines of credit really care and anything that matters like a mortgage uses a much saner evaluation algorithm that isn't going to penalize you for this.

> Medical providers effectively just send arbitrarily large numbers to insurers knowing they're never going to see much of it, but they also know they're not getting it from the customers if insurance denies it, either.

This isn't true. These things are pre-negotiated; insurance companies, however, typically mandate that cash prices are higher than what they pay. Partially because they can (due to economy of scale) and partially because with how bad billing and insurance is, a significant portion of people would likely choose to pay out of pocket if they could pay insurance rates to the hospital. If you're going to have to bankrupt yourself to pay for an expensive procedure either way, why not save your $500/month and take a vacation instead?

> When the office manager explained to me how they do billing, he told me the providers and insurance have no upfront agreement regarding what the prices of each procedure are going to be. The provider just knows there is some limit to what the insurance will pay, but not what it is.

Again, no, that's not how it works. He is correct in the sense that there is no set price for a "procedure". Each item or service is translated into a "code", and insurance companies are billed based on the codes required to complete your surgery. If you are high-risk, they might require an anesthesiologist to be present for the entire procedure (they might be anyways, I can't recall). That's another code. Each syringe they use is a code. The hospital has no way of knowing ahead of time if they aren't going to be able to get an IV into your hand, and are going to have to put one in your jugular. That's a whole new set of codes they need to bill for.

I believe the ACA did away with lifetime limits on insurance. There is no "cap" on what insurance will pay out. The higher the bill, the harder they're going to fight to not pay it, but there is no loophole in the contract that says they don't have to pay out if the procedure costs more than $X.

Another thing to point out is that hospitals can deduct unpaid hospital bills from their taxable revenue, iirc. They have an incentive to send you a bill for 4x what it cost them and then settle for what it actually cost them because I believe the other 3/4 of the bill can be counted as a loss.

> But you almost certainly will never have to pay this money. There was never a single year I actually ended up paying more than my out of pocket max.

This is probably true though. The federal government gives hospitals some compensation for bills that people don't pay. Also, as noted above, they can write some of that off of their taxes.

The hospital would probably be happy to recover 10% of that. I forgot to pay a medical bill once, they sent it to collections, collections offered to discharge the debt for $150. I didn't even haggle, on the first call they told me what I owed and said if I paid them the $150 they'd discharge the rest. My impression is that hospitals will do drastic fee reductions, because the debt is worth single digit pennies on the dollar. If you'll pay them 10% of the debt, it's more than collectors will pay for it, and probably more than they net if they bankrupt you and seize assets (once they pay for lawyers).

Hey, I appreciate the wisdom! Maybe I'll do another blog post in 6 months, or whenever I get to the bottom of how much I owe. We were in the ICU for 147 days, then home for 2 weeks, then we took her back to the ER and then were re-admitted to the ICU and we've been here now for 4 weeks and change. I appreciate your story!

My ultimate argument, is I have a sick child. I want to spend my time focusing on my sick child, not chasing bills, or calling people to chase my bills, why even bill me? Why do I need to get anything, other than the final bill? Can't they wait a year until after everything is said and done, and then bill me? By that point, everything would have had enough time to be chased, cleared, confirmed, etc.. Like, if I don't owe 2.5m, why stress me out and send me something saying I owe 2.5m? If I pay for a $4,400 out of pocket max, why can't it just be a $4,400 lump sum paid up front? Why isn't there an insurance plan that is $0 deductible, $0 out of pocket, but costs $3,000 (or w/e) per month, which covered everything? If you're going to f*ck me over, at least make it as pain-free/simple as possible I guess is what I am saying.

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