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Comment by doubleg72 | Hacker News Reader

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Let me describe the situation the other person is talking about, with two examples that happened to me in the past year.

1. I scheduled a colonoscopy with a hospital. They charged me $300 for the procedure, which I paid up front. Everything went smoothly and there were no delays, complications, or followups. A week later they sent me a bill for over $1k. They had not applied my $300 payment towards the total. They had not waited for insurance to reimburse them. They simply decided they could arbitrarily charge me more, and they did. Fortunately, my wife is somewhat familiar with medical billing and we did not pay. Insurance reimbursed them, then we called them and told them to apply the $300 we had already paid, at which point we owed nothing. If we had paid the $1k+ bill, I am sure we would not have been reimbursed.

2. I went to a clinic for a minor sports injury. They charged me a $60 consultation fee which I paid up front; I then spoke to the doctor for 15 minutes and got a prescription. A week later, I got a bill demanding an additional $180, and in that bill they claimed they had already been paid by my insurance. I checked with my insurance provider and found they had not even filed the claim yet. I ignored the bill, insurance reimbursed them, and they have not contacted me since.

Your characterization is ignorant of how scummy medical billing actually is.

> Your characterization is ignorant of how scummy medical billing actually is.

Concur completely. I once lived in a state where "Balance billing" was illegal, yet despite having a bluechip insurance plan, seeing some physicians in-network AND paying the co-pay at the same time, I could always count on being balance billed.

GRRRR. Talk about a seriously ticked off customer. Given what I know about medical billing though, I would not be surprised to hear that insurance companies were likewise trying to bilk the practices, forcing these shady responses (My wife's practice has an in-network private practice model, but insurers refuse to accept the billing rates they agreed to as a part of contract with the practice, and they play an intentional game of denials after previous authorizations, or, they intentionally send patients checks which the PTs go and cash, and fail to reimburse the practice)

FWIW for #1 if you had paid the fraudulent $1k bill, after your "insurance" paid you could have likely spent more time on the phone with the provider and gotten them to refund you. Of course if you had paid the fraudulent bill promptly they might not have even bothered billing your "insurance", meaning even more time/rounds on the phone in order to get them to do that.

I'll provide an example...while heavily medicated after breaking both of my legs I signed something on an Ipad, once. I asked for a copy and they weren't able to provide me one. After more than a dozen phone calls I was finally able to get a copy. But that involved figuring out whether it was the company that rented me the wheelchair, the company that billed me, the company that billed my insurance, or the company that owned all of those companies. They provided me three documents I had signed with not the same signature on them. Then when I asked them to pickup the 'rental' that they never told me was a rental, it took five phone calls and over two weeks (during which time they billed me and my insurance for another month of renal). They finally came and picked it up within three hours when I had the news reporter who covered my accident get in touch with the CEO's office.

I reported all this, with call recordings, logs, notes, etc. to my insurance's fraud hotline and they closed the file without doing anything.

Much of health care in the US is wrapped in a blanket of outright fraud. You can't agree to be a victim of fraud. Until I get to charge them for the time I spend correcting their billing mistakes I am totally fine deciding what bill is appropriate and what bill is not on my own.

I can count on one hand the number of times in my entire life that I've agreed to a price for a healthcare service in advance and they actually billed me the agreed upon price and no more.

Dentists tend to work that way. Now, the price they'll charge for any given service is super-arbitrary, as is what they'll claim you need. But they will quote you up-front for what they'll be charging you.

Yes, every time I can remember was a dentist.

> nothing better than someone who agrees to a service then decides later that they aren’t going to pay because now the deal is “unfair.”

I would agree for any medical transaction where the price for the service was disclosed prior to the transaction. Hell, I’d even agree if an estimate with a low and a high range were provided.

I don’t know about you, but in my lifetime the number of times this has happened rounds to 0%. And I ask for the price at a rate significantly higher than the average medical consumer.

So, since the entire industry has completely and totally failed at price transparency, then I’m completely on the side of someone who makes this decision.

When they agreed to the service 12+ years ago, were they shown the costs? Would you say their purchase was fully informed? Hell for all we know it was an ER visit and they had absolutely no say in the matter.

> Hell for all we know it was an ER visit and they had absolutely no say in the matter

This has been tried in case law, and failed. Even if you're documented unconscious, the EMTs are allowed to make a good faith assumption that you want reasonable efforts of resuscitation. Look up "implied consent" laws.

The EMTs assess your financial situation before deciding if you can afford their actions?

(Charging people for emergency treatment is one of the most insane aspects of the US system, and we need to fight it as long as possible in the UK before it gets inflicted on us)

No, they just treat everyone, and their employer sends you a bill. (Sorry if that wasn't clear.)

I understand how it works, I think you’re missing the thrust of my point. Buying a car for an agreed-on price is one thing. Opaque medical billing where we don’t even know what is covered, let alone what it costs, is very different.

And what do you do when the $10k ambulance ride isn't something you can afford?

You plead poverty with the ambulance company and hope they'll settle on a reduced amount with you. They may also put you on a payment plan, or report non full on time payment to the credit bureaus. Sometimes all 3.

You standing on this system like it is worth defending is pathetic. You are lower than a worm if you can't see the inhumanity of the system and how defending it is anti-human. If I heard you say something like this in person you wouldn't do it again.

Until our latest insurance, Ive never had a medical interaction in the US that didn't involve my wife fighting some midwit over the phone for an hour over billing mistakes.

She's probably saved us $5-10k, probably $50k for her extended family (about five nuclear families)

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