Health System in Minnesota Cuts Off Patients with Medical Debt
nytimes.com
nytimes.com
In reality I’m grateful we live in the future. One overlooked thing with medical debt is that while it’s awful, you still end up healthy at the end of it. A hundred years ago we wouldn’t have been so lucky.
It’s weird waking up in a hospital each day. Time starts to lose meaning. There are only so many times you can count the ceiling tiles.
I wonder what nine weeks in the hospital will end up being though. $100k seems not even close to the bottom line price.
Btw I understand and feel you how rough the hospital is, had 4 little ones each spending several months in the NICU hold on it gets better and the debt will eventually be gone.
Yes, 7% of the US isn't insured, which is a lot, but it's hard to believe they make up 99.9% of healthcare discourse.
Are people genuinely getting $100k in debt, or are they only telling the internet how much the total bill was and forgetting to add that their insurance picked up $94k of that.
Maybe the difference is that it was all "elective" and therefore planned out weeks or months in advance, with ample time for insurance pre-approvals?
I've had a harder time getting reimbursed for psychotherapy than they had getting covered for their surgeries.
However, prior to the No Surprises Act, you could get hit with unlimited costs from out of network providers in the event of an emergency. For example, if an anesthesiologist that was not employed by the hospital put you under, and you get a separate out of network bill from them (but that should not happen since 2022).
I'm not sure if you know how hard a surprise 10-20K bill can be. And some out of pocket maximums are huge (generally, the worse the plan is)
These systems aren’t in place for the people who fight back. They’re in place for the people who give up.
You go in for X. Insurance company defines X as a set of ICD-9 procedure codes for that health care organization, for that treatment for that indication. Not all providers will use all of those codes, usually some subset as the exact treatment may vary across providers under that health care organization. The health care organization instead sends over claims for those ICD-9 procedure codes, plus some other ones that your insurance company feels aren't appropriate for your treatment.
You then get an explanation of benefits from your insurance company, stating that they covered X, Y and Z, but A, B, C, D, E, F and G are your responsibility, because it exceeds the negotiated or "allowable rate" between the insurance company and that health care organization.
Or worse, the whole claim was merely coded incorrectly by the health care organization. Insurance company feels it's then not their obligation, and straight up denies the claim.
A through G is some amount of money that would absolutely crush the average person.
Your insurance company stands behind what they laid out in their statement of benefits for the claim, and won't budge beyond that, saying the rest of the costs are your responsibility. After all, they feel those procedures weren't relevant for the treatment, and it exceeds the negotiated allowance with that health care organization for that treatment. The health care organization's billing department is aggressive, and says since your insurance company won't pay, you need to.
TL;DR: "Balance billing."
-- -----
Here's a case where your child falling off a bicycle and needing stitches could cost you $19,000 if you don't lawyer up: https://wamu.org/story/20/11/25/a-kid-a-minor-bike-accident-...
Entirely unrelated to the specific scenario I laid out is ending up in an out-of-network emergency room. Again, easy to end up with a $20,000 hospital bill for falling off a bicycle because your insurance company says it's not their problem: https://www.vox.com/health-care/2019/1/24/18195686/vox-zucke...
I ended up forking out $58,000 (excluding 10 months of my lost wages fighting it) to attorneys to have a $412,000 balance bill for my mom ultimately withdrawn by a hospital.
When I had back surgery a few years ago, my out of pocket was something like $600. The surgery itself and inpatient was $250k, PT and follow ups went on for a year. For most HMO patients, it would be more like $5000 or more. Stuff like the supportive vest you wear for weeks is typically uncovered, cost $2500. Some plans will only cover PT for a few weeks. Today with a high deductible plans, it’s nutty - my brothers 4 kids got a nasty infection, which required an antibiotic that costs $15. Total cost? $1200 out of pocket for the visits, etc.
For chronic conditions like diabetes, supplies and scripts get expensive quickly. For cancer, if you work for Google or the US Government you’ll get treatment at MD Anderson, Dana Farber, MSK, etc for $0 and get travel reimbursement. If you have a high deductible plan, you’re going to be shelling out $10k or more a year just for the deductible, and may find yourself paying out of pocket for labs, drugs, etc.
But only up to the max out of pocket, right? Once you hit the max out of pocket, you stop paying the 10%.
So while you pay the full burden of the first $1500-$3000, you only pay a percentage of anything after that and not one penny more than your max.
Do you have a link to a real policy like you're talking about?
A few thousand to meet the OOP max shouldn't break you, or at least the government isn't going to cut you a break.
We had a surgery that wasn't completely resolved until about 8 months after the fact after spending 10-15 hours per week on phone calls. The hospital billing told me this was all normal and they usually have to resort to lawyers before stuff gets paid. SOUNDS LIKE EFFICIENCY TO ME! This is just one of a half dozen shitty experiences I've had even with $3k/mo health insurance.
So yeah, in my experience it sucks even if you are insured. The whole system is a dumbass way to do things and a huge waste of fucking time.
For "covered" expenses. Have to go out of network for a specialist? Not covered. The insurance company considers the life-saving procedure you need "experimental"? Not covered. The insurance company rejects the optimal treatment for your injury, disease or malady as being not necessary? Not covered.
Max out of pocket doesn't mean what the insurance company marketing arm wants you to believe (and most people believe).
When you actually have large medical expenses, the insurance company will use the full strenght of their lawyer army to deny everything, claim it was all unnecessary and unauthorized and deny deny deny. Your "max out of pocket" doesn't apply to any of that since they get to unilaterally say it wasn't covered. That's how you end up with hundreds of thousands in debt even though the paperwork claimed your max out of pocket is 7K or whatever.
As others mention here, you can fight it but it will become a full time job for a very long time and you'll be an amateur fighting full-time professionals at denying. You can win some but it'll be an uphill battle.
https://www.healthcare.gov/glossary/out-of-pocket-maximum-li...
Frankly negotiated prices should just be illegal. They should just provide prices for services. Insurers should have plans on how much they’ll cover you, but they don’t change any pricing. The hidden bullshit smoke and mirrors producing fraudulent pricing that may or may cover you depending on a million different reason is as far from market competition as it gets.
Sadly, if you're sitting around a hospital room, researching and reading up on insurance billing is probably a worthwhile use of time.
It does suck that the burden of the payment falls on the patients, but if you know the system well it doesn't have to be that stressful.
Who should the burden of payment fall on it not the patient seeking care?
A huge majority of Americans do at least have some level of insurance coverage with a max out of pocket which helps, and our Healthcare system is horribly designed with regards to keeping costs low, but really where else should they send the bill?
The abnormally high costs of medical services in the US stem from more issues than just the lack of universal healthcare though, and I have no idea how to solve that problem.
There are at least a few easy changes that could help bring down costs, but they wouldn't be popular. Rolling back much of the legal precedent for malpractice lawsuits would definitely help. Doctors need to be given the freedom to do what they do best, problem solve and treat each patient individually rather than cover their own ass.
Yes that is not a surprising caveat, that is the point. It's fairer to everyone, in my opinion, and in practice in many countries. I understand it's not that simple in the US but the concept of spreading the cost across everyone's taxes is the same. That is what insurance is afterall, and people seem to be fine with that.
In reality, there’s some hidden, pre-determined rate that the hospital and insurer have agreed on.
We forgot to add our daughter to insurance when she was born. Dr provided us with “uninsured best estimates “ that were 1/10th what’s billed to insurance. That’s the true cost of healthcare.
Our response to issues like obesity and other long-term things is just horrendous - almost always trying to treat symptoms instead of causes.
There isn't much you can do about the causes: many of them are intrinsic to the American lifestyle. Come to a country/city where people have to walk everywhere, and you won't see many obese people. That isn't doable in America because almost the entire country (except Manhattan NYC) is designed around everyone using cars to go everywhere, and walking being almost impossible or at least horribly dangerous without getting in your car and going someplace far away specifically meant for that activity.
We need more layers below doctors that can very effectively treat typical healthcare conditions. We need more NPs and PAs. Perhaps more doctors too - if we can lower the rigor and regulation for family doctors. Make it easier to become one - preferably without losing one’s shirt.
An analogy to healthcare today would be to only allow someone to code once they reach Staff Eng (MD) skill level. Most of them spend the majority of their time fixing bugs that a Jr. Eng (PA in training?) could fix with guidance, or a SE 3/4 (PA/NP) could fix on their own.
So, no - filling the work with Staff+ Eng (MD+) is not the most optimal or cost effective way of dealing with this.
Staff (pun) aside, there’s also the whole drug price gouging situation. I don’t know how will we fix that.
Competition does nothing to reduce isolated under-patent drug prices because it's not supposed to.
Competition does nothing to reduce one of a couple of specific generic drug prices like insulin and epinephrine because of some very, very stupid FDA policies that make it like they're under patent without any of the drawback of the patent actually expiring.
Competition is incredibly good at bringing down the prices of generic drugs, competing separate under-patent drugs like depression treatments, and things you do mostly pay for yourself like glasses.
Re: doctors, we don't need less-skilled doctors, we need less-debted doctors so doctors are less likely to seek high pay despite less fulfillment. We currently require a four-year degree in literally anything before you can start medical school; Ireland does not and just pads med school with a single extra year for GE, and their doctors are about as good as ours. Competition also doesn't work when it would drive your prices below cost, and medical school debt makes it effectively like that.
All other evidence I’ve heard of points to the USA being the only major country without public healthcare and price controls in place, but maybe you can blow my mind with facts.
Recouping R&D costs has been disproven time and again. Medical companies spend far more on average on marketing (and lobbying) than on actual R&D.
This is patently false. You might be alive at the end of it but that isn't the same as healthy.
There is absolutely a lack of resources when it comes to medical care. There aren't enough nurses, doctors, mental health professionals, specialized medical equipment, or in some instances even blood, to go around right now.
This "post scarcity" mentality isn't based on reality.
Contrary to what we would like to believe, there is a scarcity of intelligent people willing to devote their entire lives to the study of medicine across specialties.
If you cannot afford it, the US healthcare is terrible. If you have the means to afford it, the US healthcare system is one of if not the best in the world.
This is untrue according to all metrics I have seen (such as life expectancy). Do you have any evidence to back this statement up?
10 of the leading 12 causes of death are diseases, with the first non-disease cause coming in at #4.
You can see the breakdown of life expectancy reducing factors here, none of which are attributable to "limited specialized treatment": https://ourworldindata.org/us-life-expectancy-low
https://www.gbhoh.com/fentanyl-becomes-leading-cause-of-deat...
I still fail to see cars and guns being the leading cause of death.
Do you see something I don't?
https://peterattiamd.com/anthonyhipolito/
https://www.statesman.com/story/news/politics/politifact/202...
The point under debate is guns and car accidents being asserted as the leading cause of death. I continue to assert it is not true.
Many of our worse outcomes though have nothing to do with the healthcare system. The decrease in life expectancy is being driven by factors like obesity, substance abuse, sedentary lifestyles, vehicle crashes, suicide, and violence.
That's unfortunately not even the case. Americans spend more money on healthcare AND have worse outcomes.
https://jamanetwork.com/journals/jama/article-abstract/27843...
https://www.healthsystemtracker.org/chart-collection/quality...
https://www.pgpf.org/blog/2022/07/how-does-the-us-healthcare...
None discuss outcomes among only those who "have the means to afford it" so none of them refute GP's claim.
This might be true in theory but is somewhat irrelevant here given the gargantuan levels of waste in US military spending.
There is also gargantuan waste in healthcare costs, but those are spread out via insurance, not taxes.
The presence of gargantuan waste in both sectors and the different avenues of spending both make any after-the-fact, simplified explanation of why one costs more than the other kind of moot.
The presence of gargantuan waste should also be addressed before implying that the costs of healthcare are all presumed necessary.
Why? Are money and social status insufficient motivators? Or is there another reason?
In the US, we ration by price… “the doctors expensive and I don’t feel too bad so I’m not going to go”. In Europe, they ration via lines… you’ll get your free healthcare eventually.
Either way there are problems, but seems like other countries might be onto something
It is an important distinction. For example, about 33% of healthcare dollars go to paying “claims proceesing” people at your insurance company and your doctors office to haggle with each other and produce duplicate paperwork.
If the low end of your estimate (5x) is the correct multiplier, the money that goes to claims processing would be enough to pay for universal healthcare in pretty much any other first world country.
Other things, like absurdly high drug prices, also are not healthcare spending. 90+% of drug discovery research money is spent at universities, and not by pharmaceutical companies. Also, those companies pay more for prescription drug advertising than for drug research.
I'm not sure what point you're trying to make about drug discovery research. The major expense in bringing a new drug to market is not in the basic research but in the phase-3 clinical trials. Those often cost pharmaceutical companies upwards of $1B now.
https://www.gao.gov/products/gao-18-40
By comparison, several major tech companies have significantly higher profit margins.
This is not true, but there is a big non patient healthcare services culprit in US healthcare costs, and that is legal liability. In the US, every entity in the healthcare chain is doing so much extra to prevent themselves from being liable, and charging extra in case they are found liable, that it inflates all costs dramatically.
Without tort reform, I doubt we see much improvement.
Afaik this is simply not true, and even if it was, this would be misleading if you consider that most costs are made during clinical trials, which test the effectiveness of the drug.
The US medical system has been systematically optimized for extracting the maximum possible amount of money from every patient, part of which is artificially restricting available supply of medical care (although things are slightly getting better in that regard with practicing nurses and PAs)
The other thing it was optimized for was hiding this from the patients.
And only now, in 2023 are we beginning to see the horrible extent of this, because of price transparency rules.
Then again, it should be matter of at least a majority agreement that things like that should be paid from taxes, and it's obvious that in the US the agreement is not there.
Are you seriously arguing against taxpayer-funded education? As broken as U.S. public education is, managed as it is by hyper-local, ideologically-motivated officials, withdrawing the opportunity to raise one’s lot in life through community-funded education would be pretty dystopian.
Or perhaps you were referring to post-secondary education only?
Many of these really aren't resources though. Lumber, iron, and oil are resources but shelter, medicine, and utilities are all products made with resources. Education isn't even either, it's a service.
Whether they are all necessities today is up to opinion, and I expect the are good arguments to be made that they are all necessary, but they definitely aren't resources.
I'm sure the comparisons have been made for many years, but by mid-2020 it felt like almost everyone in the USA must have been exposed to some hard truths about how 'the rest of the west' handles these fairly fundamental services.
As an Australian, and I suspect the Brits and others feel similarly, the pandemic also reminded us of what we stand to lose if we were to allow the eagerly nefarious agents to talk us out of (AU) Medicare or (UK) NHS, etc.
You'd hope, but that type of facts and rhetoric wasn't seized upon by the media or political parties. A good amount of people were never exposed to that information nor its consequences, let alone the consequences of our negligence towards health and social services.
People were happy to get some checks and extended unemployment, and a lot of people were angry about those checks and extended unemployment. A good chunk of people wouldn't have given a shit about how well your country was doing if you were wearing masks.
You say it wasn't seized upon by media etc, but perhaps it just wasn't by the media you (or I) was consuming? The USA media I consumed - Seth Meyer, John Oliver, some reddit / imgur - tends towards the more thoughtful / empathetic / liberal demographics, but unarguably is a bubble of sorts.
I suspect, but also have no hard data, that the younger generation, generally more 'connected' and exposed to more of this type of information, was instrumental in extracting that orange chap, and I speculate much of that motivation came from this vector. Though how much of that was pandemic-highlighting of poor and unfair health services vs other factors .. well, who knows. Exit polls only get you so far, assuming these kinds of questions were ever asked.
My greater point was that during COVID19 we had the unique situation of a health crisis that presented almost equally to everyone on the planet, so deltas in responses were very obvious, and depending where you were and what your politics were, very useful for finger-pointing (of the 'at least we're doing better than them' or 'we should do what they're doing' varieties).
To your point - I don't think we were imprisoning people who declined to be vaccinated - not sure where you may have got that story from. We had the benefit of vaccines not being anywhere near so politicised, and our local Faux News outpost certainly wasn't promoting any anti-vaccine nonsense.
Lockdown laws I think in most western democracies were similarly orchestrated and enforced, but obviously I only lived through one set. Whether they were perceived as draconian, or successful, probably depends on your sense of social concern / obligation.
https://ourworldindata.org/grapher/cumulative-excess-deaths-...
Sorry for the confusion! I guess different stories are starting to blend together from all the pandemic response hysteria and I should have checked that myself before posting.
I had friends that tried to get back from the UK to here around that time, and the delays were awful (several months) though somewhat complicated by immigration for one, rather than outright citizen return for both. As it happens they spent two weeks in that same center, before being allowed to proceed back to the southern states. From the outside looking in, it felt like a small price to pay. Most of our escapes through 2020 and early 2021 were due to poor process control at airports
I think that AU and NZ citizens were pretty happy, for the most part, with the isolation & controls --> good health outcomes, so the two week quarantine was doubtless uncomfortable for many, but these exceptional cases of some tiny number of sociopaths trying to selfishly circumvent due process were so rare that they were necessarily notable, especially amongst the international press.
BBC was probably pretty even-handed, but certainly some more reactionary media outlets (you know who I mean) were keen to try to beat-up the situation into something it was not.
ACA/Obamacare is unconstitutional as it is.
Not saying whether this is good/bad. Simply stating the facts.
> “Allina Health’s goal is, and will always be, to have zero patients go without services for financial reasons,”
... while explaining why they made the choice to withhold services for financial reasons. It's their right to do so, but don't lie about it.
I'm confused. There is out of pocket maximum of $18,000 for a family that caps what patient has to pay for in a given year. That's the law. For ER room, you don't have to worry about out of network hospital.
These articles help politicians deflect from the fact that no one other than the US government could possibly provide unlimited healthcare. An individual hospital or healthcare business deciding it cannot afford the losses is just that, a business decision. And since it does not have the power to raise taxes, that is what they have to do.
Not even they could do that. I've lived in a country with universal government-funded healthcare; many things are better than the US system (low bar, I know), but wait times are very long and standards of care aren't magically any less sucky.
There are definitely examples of universal healthcare that seems to operate well in small universes.
From CMS on National Health Expenditure [1]:
> NHE grew 2.7% to $4.3 trillion in 2021, or $12,914 per person, and accounted for 18.3% of Gross Domestic Product (GDP).
> On average over 2021-30, National Health Expenditures (NHE) and Gross Domestic Product (GDP) are both projected to grow 5.1 percent per year; as a result, the projected NHE share of GDP in 2030 (19.6 percent) is similar to 2020 (19.7 percent).
McKinsey [2] cites
> Of the nearly $4 trillion spent on healthcare annually in the United States, administrative spending is about one-quarter of the total; delivery of care is about three-quarters.
Nearly a trillion dollars in administrative spending that could otherwise go into care delivery! (Yes, some administrative spending will remain, but the pie is so large).
That just shows that entrenched forces are strong.
[1]: https://www.cms.gov/research-statistics-data-and-systems/sta...
[2]: https://www.mckinsey.com/industries/healthcare/our-insights/...
1. Is prescriptions people talk about how medicine is too expensive and they have to ration it.
2. The other problem is the surprise medical billing that people get hit with. that lasts forever and cripples them.
These seems to be the.major complaints I hear about the healthcare system, and yet are 2 very different issues with different origins and solutions.
Yet no one seems interested in solving the problems but instead just arguing (for and against) about universal healthcare or single payer healthcare or whatever the euphemism of the week is.
No amount of medical intervention is going to fix terrible lifestyle choices and a culture that promotes them. There are a multitude of factors that go into making our lives decay to the point of needing medical treatment and those are things we should be focusing on.
Doctors aren't miracle workers. Why is the CEO of McDonalds not required, by law, to eat Big Macs for 2/3s of his/her meals every day?
Should we force alcohol vendors to drink only alcohol?