Comment by mightybyte | Hacker News Reader

Comment by mightybyte | Hacker News Reader

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I'm also really hopeful for this. A couple years ago I had a potentially serious injury and the local urgent care clinic said I needed a trauma center. The message got lost in translation and I ended up at a Northwell Health hospital that did not have a trauma center. First they ignored the documents that I gave them and let me get past their triage so they could bill be and then told me that I needed a trauma center. After signing a refusal of care form and paying something like $200 to get out after getting zero care, I went to the nearest hospital with a trauma center where I was very quickly received by a full trauma team, got a CT scan, and determined that my condition was not serious.

I got a bill from the trauma center hospital for something like $500. Based on what I've been conditioned to expect from the U.S. health care system that seemed pretty reasonable. Then I got a bill from Northwell Health where I recieved no care for more than $800! Around that same time the NY Times came out with a piece about Northwell overcharging (https://www.nytimes.com/2021/03/30/upshot/covid-test-fees-le...). It took me months of badgering both my insurance company and Northwell to stop sending me payment delinquency notices.

Now, more than a year and a half later, they started sending me bills for that $800 again! So I'm very excited to see this kind of open source approach at this problem.

This is why you don't go to urgent care clinics. Half the time they don't even have doctors there, just NPs with online degrees.

It sounds like you inprocessed at Northwell Health, went through billing, saw a Nurse/PA/NP, got vitals taken, met with an ER Doc, and received a confirmatory diagnosis, and the ER doc spent the time to read your documentation.

For a hospital, your care is not merely the interventional aspect of medicine, but also the vitals, diagnosis, charting, and time spent on reading your documentation by a medical professional with > 20,000 hours experience & training.

If I take my car to a shop, the shop contemplates my car, and concludes that they can’t help me on that visit (because they’re the wrong shop, they have the wrong part, etc), the usually charge me $0. Maybe $15.

I have never in my life experienced an ER doing anything competent that remotely resembles reading documentation as part of triage. Why on Earth should they get paid more than a tiny nominal fee for the use of the waiting room and a bit of time spent by the triage staff?

My understanding is that this is because the car repair market is heavily regulated, estimates are required for all repairs, and payment is based on a standard number of hours for each job, not actual time taken. The cost of estimates is already wrapped into the cost of the completed repairs, and estimates are required before work is done, so few places charge for declined estimates.

https://www.bar.ca.gov/pdf/writeitright.pdf

I think it's because car repair shops can't get away with being a total dick.

Exactly.

"Terell's cousin is handy and while he's not the greatest he can probably get 'r done for more time and frustration but a lot less overall expense" is the nuclear option that caps how big a bag of dicks a shop can be.

Barrier to entry is low and they don't have an AMA cartel lobbying the government to protect them which helps a lot too.

>If I take my car to a shop, the shop contemplates my car, and concludes that they can’t help me on that visit (because they’re the wrong shop, they have the wrong part, etc), the usually charge me $0. Maybe $15.

Because you're a regular.

If you're not a regular customer of theirs expect a diagnosis fee that's about equivalent to half an hour of labor.

Yeah, but you are still informed of, and sign agreement to the diagnostic fee.

They also won't charge you a diagnostic fee if they know ahead of time that it is a service they won't provide like in the example. If I somehow end up at the tire shop for an AC service, they don't send me a bill 6 months later for an arbitrary amount just because they had to tell me that I need to go to the shop down the road for my issue.

I don't live in the states anymore, but I genuinely don't understand how any of this is legal. If I started sending out invoices to every client months later for services that they didn't know they were getting, with arbitrary prices, sometimes with egregious errors on them, I would expect a knock on the door from the authorities.

If the human body was as easy to fix as a car you might have a point.

They had a full report from the urgent care clinic including x-ray and blood test results. They added precisely zero value. It was a completely inexcusable failure of triage, solely to extract money. I paid the $200 or so on-site, and even that is not defensible IMO.

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