Comment by maxverse | Hacker News Reader

Comment by maxverse | Hacker News Reader

NPR has a series of these "Bill of the Month"[1] articles about surprise medical billing, and I am not exaggerating when I say they are the single most depressing, scary, disheartening thing I read on the internet.

The patients in these stories seem well-intentioned and well-prepared. They double check that their doctors are in-network. They triple-check what charges they should expect. But there's always a gotcha. There's always some hidden, between-the-lines reason hospitals come up with to charge you, and insurance won't cover. In one story, the surgeon invited an out-of-network surgical assistant into the surgery, without notice. In another [2], the labor and delivery department was classified as an ER, for a completely routine delivery.

When these charges are dismissed, it's always because NPR reached out for comment, and the hospital backs down, presumably because of the bad PR.

The unpredictably and seemingly arbitrary nature of medical charges makes me feel... queasy. And scared to seek medical help, which I know is what insurance companies want. Even with great insurance, which I'm lucky to have, it feels like there's nothing I can do to prevent medium-to-insane charges. The only way I can think of to try and combat medical billing is to retain a lawyer.

[1] https://www.npr.org/series/651784144/bill-of-the-month

[2] https://www.npr.org/sections/health-shots/2020/07/22/8919096...

[3] https://www.npr.org/sections/health-shots/2021/10/27/1049138...

In my experience they are just outright lying and believe that patients will pay anything they bill. When my first child was born I received a monumental bill from the anesthesiologist, with the slight problem that no anesthesia was used and the person in question was not in attendance. Later, after I'd filed the consumer protection complaint with the office of the state attorney general and a formal complaint to the medical board of California it came to light that this person was golfing at the time, in another country. So it was just fraud.

The problem with this system is they act like everything is fine after they drop their claim, but what needs to happen is people going to prison. This is large-scale white collar fraud and it should be getting much more media attention than some guys stealing shampoo at the Walgreens.

It's two sided.

The people getting service often are not ones actually paying (insurance pays, medicaid, medi-Cal etc).

The whole billing thing can be pretty darn maddening for providers as well.

There is absolutely no public pricing.

One thing I couldn't stand. A bunch of policians want to talk about how much money various govt programs save. So they do things like lower of cost or contract (penalizes you if you deliver to much service for same price) or some % of your charge sheet (ie, 50%). If 90% of your patient load is going through these programs, you basically have to set your cash pay charge to 2x it's normal cost, so that all these players can then report "savings".

The reality is there should be a cash pay DISCOUNT, you pay 80% if you pay in cash. But all these programs will not pay more than cash pay even though the overhead of dealing with them is massive. Ie, probably should pay 110% of a reasonable rate.

I don't quite understand how they get away with it, in the most litigious country on the planet.

Also, surely there's a hefty opportunity for someone to be providing a service to audit and reduce bills for x% of the reduction?

They get away with it because people have internalized that right-wing meme about "most litigious" to make it seem like the problem is greedy individuals abusing the system, when it's the opposite: greedy organizations are abusing the system and using right-wing memes to foreclose the legal remedies of individuals (such as via malpractice award limits).

Emphasizing this from the article:

> Martand received almost no medical service. A nurse practitioner looked over the toddler, listened to his heart and stomach, and looked in his nose, mouth and ears, according to provider notes prepared by the hospital and shared with KHN by Bhatt.

> The nurse didn't change the dressing on the wound or order any testing.

> Emergency visits are usually classified for billing on a scale from 1 to 5. Level 1 is minor and routine; Level 5 requires complex care for life-threatening conditions. [...] Despite the lack of severity of Martand's wound and the absence of medical care, his visit was classified as Level 3, a moderate severity problem.

> In an email, Zoller Mueller said the charges were "appropriate" based on the "acuity of condition, discharge instructions, vital sign monitoring, traumatic wound care [and] numerous assessments."

> She added: "A patient does not have to receive additional treatment — procedure, labs, x-rays, etc. — to validate an ED [emergency department] level charge."

Just because a hospital is big and has expensive lawyers, that doesn't mean that you have no rights.

My wife got a 4k bill that had no information on it other than the amount due. I called the hospital and asked what the bill was for and they said they would send an itemized bill, they never did, but I did get a letter from collections and I called them and said that I dispute the charges. And I never heard anything about it again.

You have rights also; the right to file for bankruptcy.

I had a family member get seriously ill and we racked up a ton of medical debt. There was no way in hell we could have paid it off and continued to live on one salary.

Filed for bankruptcy, and two years later started off with a clean slate. Honestly credit was back into the 700's, bought a new car and a new home two years later.

You have to know that you can dispute the charge. Many people would not know that.

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