Comment by jccalhoun | Hacker News Reader

Comment by jccalhoun | Hacker News Reader

The insurance industry in the USA is so screwed. A few years ago I had to go to the emergency room (turns out it was my gall bladder) and afterwards I got separate bills from the hospital, the anesthesiologist, and the mri. It was one hospital but it turns out it was 3 separate companies.

Of course I didn't get the bills right away. No I got them for months afterwards.

I got the main bill, I called up the hospital to pay and they said they would give me a discount for paying all at once. What? it didn't say that anywhere on the bill. So if I had paid it online I would have paid the full amount and not the discounted price which was a couple hundred less?

Another time I got a bill from the hospital and I didn't know what it was for so I called them and they said "ok. We'll resubmit it to your insurance." and I never heard about it again. If I hadn't called I would have paid a bill for over a thousand dollars.

I got one bill for $20 a year after. The address was in another city so I was skeptical. I went to their website and put in the account number and it said I didn't owe anything. Was it a scam? Who knows.

Another time I had an mri scheduled for something else and I get a call from the insurance company asking if I would be willing to reschedule to another hospital 90 minutes away because it was cheaper.

I can't imagine how terrible it would be if I had some serious or long term illness. Imagine if any other industry was this sloppy and confusing in their billing.

>The insurance industry in the USA is so screwed.

One of the steps that seems symbolic, but is important is that we need to recognize that health insurance only bears a passing resemblance to insurance.

What it really is: A "savings" account, or amortized payments for expected expenses. The value-add is that these companies will negotiate volume discounts (sometimes, when things don't actually cost more than they would on the street) for some providers and interventions.

You/your employer pay a premium.

Then you have a deductible.

Then your "insurance" company has the unmitigated gall to also include "co-pays" (which are on top of your deductible, as well as after meeting it), AND "co-insurance" (even if you've already met your deductible)...

AND then they'll refer to it as "your contribution to your healthcare costs". I suppose that is somewhat accurate but still...

Imagine your car gets totaled. Your insurer says "Hey, we're going to pay out $25K for your vehicle. So you have a $1,000 deductible, so that's $24,000, and then your copay for a total loss is $2,000, and for total losses, your coinsurance as your contributions for your vehicle coverage is 20% which is $5,000 so here's a check for $19,000."

I know it exists in certain very limited contexts, but if it weren't for all the regulatory capture, I could easily see companies that say "We'll negotiate bulk discounts with these providers. Everything else is on you. Pay for what you use."

> Imagine your car gets totaled. Your insurer says "Hey, we're going to pay out $25K for your vehicle. So you have a $1,000 deductible, so that's $24,000, and then your copay for a total loss is $2,000, and for total losses, your coinsurance as your contributions for your vehicle coverage is 20% which is $5,000 so here's a check for $19,000."

Err, $17,000...

Putting that in a followup post is more accurate. <chef's kiss>

At the end of last year my doctor prescribed a list of blood tests, some of them rather esoteric and cutting edge. As a precaution, I wanted to see if they would all be covered and how much my out of pocket cost would be for these if not (or if partially covered).

It took _a week_, composed of two different lab visits and about 4 hours of phone time between the doctor, the lab, and my insurance to figure it out. And in the end, the values ultimately provided to me weren't even correct.

Like what the fuck is going on behind the scenes here?

> behind the scenes here?

Two giant companies, trying to fuck each other as hard as possible, while not violating the law so egregiously they are made to stop. Healthcare is an incidental byproduct.

Insurance companies have negotiated rates with individual doctors, hospitals, and even individual procedures.

Depending on facility, negotiated rate between insurance and facility, and “in network” vs “out of network”. the amount “billed” can change dramatically.

Even different plans within the same insurance company can often change the cost to patient.

In the USA, there is at least some degree of transparency from hospitals to list their cash prices. But it’s most inaccessible to the common person.

Some of the lists are massive and it’s often ordered by cryptic ICD codes. Some third parties have tried to standardize it and make it easily searchable, but I honestly haven’t followed up on it.

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