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Comment by doctortheow | Hacker News Reader

This is nice and I hope it becomes standard. I have basically not been to the doctor in 7 years because of medical bill fears.

I work at a big tech company and have theoretically very good insurance, but I have heard stories where the insurance gets declined even though they say they take it… or some lab specialist is using a different insurance network and you have no control over using them. If I don’t have coverage then there is nothing stopping them from billing me like $1m as far as I can tell, after the fact, when I can’t just decline the service. It’s insane that they can’t say what it will cost up front.

My company switched insurance name but not network and doctors didn’t understand it and started denying the claims… even though they were technically in the network! That’s when I gave up, after reading other employees’ reports of that.

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"I have basically not been to the doctor in 7 years because of medical bill fears."

I mean this kindly, but your concerns are not rational. Every middle class person I know goes to the doctor from time to time and has somehow avoided $1m dollar bills for providers listed as covered by their insurance.

While our system is bad, you are greatly overestimating the probability of something very bad happening to you.

You have healthcare and good insurance and presumably make a good amount of money working for a big tech company.

A checkup will not end up with thousands of dollars of bills, schedule a routine health-check, you can also call your insurance first to check what is covered.

The 2022 No Surprises Act (https://www.cms.gov/newsroom/fact-sheets/no-surprises-unders...) reduces the occurrence of this, but huge bills from a simple checkup have definitely been a thing.

https://www.npr.org/sections/health-shots/2018/02/16/5855481...

> After Elizabeth Moreno had back surgery in late 2015, her surgeon prescribed an opioid painkiller and a follow-up drug test that seemed routine — until the lab slapped her with a bill for $17,850.

https://www.npr.org/sections/health-shots/2019/12/23/7874035...

> The visit was quick. Kasdan got her throat swabbed, gave a tube of blood and was sent out the door with a prescription for antibiotics. She soon felt better, and the trip went off without a hitch. Then the bill came. Total bill: $28,395.50 for an out-of-network throat swab. Her insurer cut a check for $25,865.24.

Just coming to add that if it's been 7 years of no checkups, you are possibly getting into the age bracket where routine checks can make meaningful differences in longevity and quality of life.

Highly recommend not going through middle adulthood without at least having annual physicals.

There are a lot of things that happen to bodies that are easy to treat if you know about them soon enough.

It sounds like you may need help using your insurance; call the insurer from the physicals office if the office won't call the insurer. Healthcare in the US is a tremendous administrative burden on us all, but overall it is still necessary.

If you live in California this practice of out-of-network providers giving surprise bills at in-network facilities was ended in 2017 [1].

Federally, this practice was ended January of 2022 [2].

Go to a Doctor and get a checkup.

[1] https://www.insurance.ca.gov/01-consumers/110-health/60-reso...

[2] https://www.help.senate.gov/chair/newsroom/press/senator-mur...

Did you consider the impact of missing out on preventative care?

Have you seen a dentist? The dental coverage from employers feels much more limited (except for preventative cleanings) and you can expect some not so fun problems if you miss so many cleanings.

If you get a bill you don’t agree with, just don’t pay it. If you want to spend the time on it, you can ask for full itemized bill and when they send you something, tell them you want more detail. You can let it go to collections and settle for a lesser amount. Or just ignore it, unlikely anyone is going to credit bureau or garnishing wages over less than $5k.

Only do above with doctor you don’t plan to see again or anesthesia/lab company. Your insurance company will have a list of doctors in network, print it out and ask for front office staff to verify over email.

> Or just ignore it, unlikely anyone is going to credit bureau or garnishing wages over less than $5k.

They absolutely will do so. https://www.reddit.com/r/CRedit/search/?q=ambulance&restrict...

If you get a bill you don’t agree with, just don’t pay it.

That is the way. A couple of years back, a physician tried the out-of-network labs scam with me because they try it with everyone. It does like this: you piss in a jar at the intake visit, the physician sends it off to an out of network lab for high-complexity drug screening, and you get presented with a 4-digit bill.

Everyone is innocent, the physician said "you peed in the jar", the insurance says "out of network", and the scam lab says "services were rendered". When you make it clear that any bill will be disputed and attempts to collect will end up in court, they settle for 0 dollars.

They still tried the same on my wife, a few months later. All physicians are scum of the earth.

Or just call the hospital's financial office. I've got a stay from a several years ago I'm still paying off. They offered me $50/mo. at 0% interest without me even asking, and why not? Free money, $50 5 years from now certainly being worth less than $50 today.

I've had a delinquency on my credit report for years from Verizon Fios for ~$200. It was a clear error on their part, but I still wasn't able to get it removed. I wouldn't be so sure ignoring a $5k medical bill won't have any consequences.

I mean, the consequence is that you won't be able to borrow money. On Big Tech salary, you can pay cash for things that a lot of people borrow for.

If you already own your primary residence and you bought in 2021, then you're pretty much locked into that home for 30 years. Interest rates will never be 2% again. So, what is your credit even going towards?

On the same note, you can just show up at your favorite doctor and say you'll pay cash and not tell them your insurance information. My doctor tends to bill my insurance company $200 for an office visit. This is unlikely to be a significant hardship for a software engineer.

Well sure, if you’re going to construct a scenario where a credit score hit will have no impact on someone because they have no need for credit in the next decade, then they can certainly go ahead and ignore bills.

You’re making a lot of assumptions though. What if they don’t own a house yet? A bad credit score will make it harder to get one, increase the interest rate if they can even get approved, and also make it harder to get approved for a rental lease too. Or maybe this person is all set like you describe, but they want to guarantor a loan or a lease for one of their kids? I think credit scores are a borderline scam, but it’s hard to avoid relying on them for one thing or another for most people.

You paid and had a credit problem. I didn’t and haven’t had any issues. Seems like the better solution is to ignore it until you can’t

Sure, people can roll the dice if they want. It might work out like it did for you. Or they could end up with an unremovable delinquency that gives them poor credit for years. Unless you have data to back it up, I wouldn't be telling people that the risk is low based on a single experience you had.

Good to hear from you. I hope that we can offer you peace of mind on pricing! We want people to not have to worry about surprise bills. We are working on sorting out the in-network/out-of-network lab situation soon as that's been a common complaint we hear from patients.

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