Doctors Are Fed Up with Being Turned into Debt Collectors

https://www.bloomberg.com/news/articles/2018-11-15/doctors-are-fed-up-with-being-turned-into-debt-collectors

by lxm • 8 years ago

116 164 8 years ago

jedberg• 8 years ago

Doctors being debt collectors is annoying for both the doctor and the patient, and they're also bad at it. Just the other day I got a bill for a procedure in July of 2017, despite 1) not having seen that doctor since 2016 and 2) never having had that procedure. Now I have to fight with them to prove a negative, until it goes to collections and I can make them prove the debt, and then wait for my credit to get fixed after they figure it the debt isn't valid. Yay.

ndiscussion• 8 years ago

You have my sympathies. My insurance keeps sending me a bill for $5 for "unpaid services". Every time, I tell them everything is accounted for, and they remove the charge. Only to get another one a week later.

toomuchtodo• 8 years ago

I suggest when you reply regarding the erroneous charge, you send it certified mail return receipt ($7 at your local USPS), and build a paper trail. It ensures any discrepancies will be resolved in short order if you need to pursue legal remedies.

Conversely, when you make payments that you might encounter turbulence on, write a check (I know, gasp) or a USPS money order. Once it clears, save the front and back of the check images as proof of payment (for the money order, save a copy of the receipt and the entire check and receipt assembly prior to mailing or delivery). I've found this to be much more effective than a debit or credit card line item on a statement.

There are few weapons more powerful than a properly assembled paper trail, and the mere act of showing you're building one is usually enough to get action taken.

chrisjc• 8 years ago

Agreed. Just got contacted by collections about unpaid services. Contacted the doctor's office about this and they said our insurance denied the claim and they couldn't get in touch with us to resolve the matter. Turns out they were submitting to our old health insurance company, and using our old home address. We were also at this office about 3-4 times before and 3-4 times after the procedure that went to collections.

Tangentially, we've started to notice that doctor offices will often claim that procedures aren't covered and we have to pay out of pocket. However, we keep track of these out of pocket expenses since we're close to hitting out of pocket maxes. Turns out most of the time, the doctor's offices will still submit the claim to our health insurance company even though we paid, effectively double dipping.

Also, the amount of time spent following up with doctors, payments, procedures, claims, etc is mind boggling. At least 4-8 hrs a week. Getting an answer about what is and isn't covered also seems to be some kind of black art.

FireBeyond4• 8 years ago

Tangentially, we've started to notice that doctor offices will often claim that procedures aren't covered and we have to pay out of pocket. However, we keep track of these out of pocket expenses since we're close to hitting out of pocket maxes. Turns out most of the time, the doctor's offices will still submit the claim to our health insurance company even though we paid, effectively double dipping.

Let's not beat about the bush, this is _insurance fraud_, not "double dipping". The provider has to assert to the insurer that they have not been paid for that service rendered when they bill insurance.

old-gregg• 8 years ago

Poor "providers"... They charged us $250 for a can of apple juice and two Advil pills (AKA "recovery kit") after a broken wrist surgery, which itself was $45K without a hospital stay.

No wonder they now have a "problem" having to chase non-paying people. It's like charging $10K for a handshake and then sponsoring an article on Bloomberg about being unable to collect it.

jstewartmobile2• 8 years ago

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blang• 8 years ago

You will notice with most (probably all) things medically billable the amount the insurance company pays is lower that the billing amount, that is the insurance company's negotiated rate, setting that price is one of the central things insurance companies do.

beckler• 8 years ago

I occasionally get random bills from "providers", and I think it shows just how awful medical billing is.

The worst was whenever we had our first child. I thought it would just be a single bill or something, but instead I received about 10.

One from the hospital, one from a surgeon, one from the OBGYN, and one from an anesthesiologist. We only met one pediatrician during our stay, but we received a bill from every pediatrician that did a rotation while we were there, so that added four more. One because a nurse working was an independent contractor, and one from the wet nurse who we talked to for like 5 minutes.

Two of them we never actually received bills for because they had an outdated address, so they were sent to collections. We discovered them a year later when we were trying to buy a house. It dinged my wife's credit so bad that we were recommended to not put her on our mortgage application.

ransom1538• 8 years ago

"One from the hospital, one from a surgeon, one from the OBGYN, and one from an anesthesiologist. We only met one pediatrician during our stay, but we received a bill from every pediatrician that did a rotation while we were there, so that added four more. One because a nurse working was an independent contractor, and one from the wet nurse who we talked to for like 5 minutes."

This is it. This is the US medical scam crystallized. What you need to focus on as a US patient is the "Out-of-pocket maximum/limit." (a number) - which is the yearly maximum you pay as an insured person. Basically, once you enter into an ER you are going PAY this this number. This number is reset every January 1st. So If you have a child January 2nd -- you are in GOOD* shape -- since you will hit your yearly max ("Out-of-pocket maximum/limit.") early in the year -- all other medical is free.

My friends that had a child December 30th, are in bad shape. They pay for yearly "Out-of-pocket maximum/limit" two times: one for the current year and one for the next year.

_emacsomancer_• 8 years ago

It dinged my wife's credit so bad that we were recommended to not put her on our mortgage application.

I've been through this sort of thing, and it's ridiculous. Medical bills shouldn't be able to affect one's credit rating.

TallGuyShort2• 8 years ago

I got a notice from a debt collector and I disputed it. The proof they provided was a hand-written note from the doctor, and a copy of the hospital's form my wife signed (while in hard labor, mind you) agreeing to pay the hospital. But the hospital had no record of a doctor by that name and could not confirm the legitimacy of the bill. Neither could anyone at the contact address provided.

It ended up going to court and it was judged to be a legitimate bill that I had to pay. That's how bad the system is.

pishpash6• 8 years ago

That's old school. The latest scam is for hospitals to buy up all the independent neighborhood clinics, and then double charging for services there. For the same service, the doctor at the clinic will charge their usual fee, then the hospital will charge another one for the privilege of hanging their name at the door -- it's called a "facility fee", because you see, by stepping in you've entered a "hospital" even though nothing has changed [1]. For a routine visit, as an example, you pay for the doctor's service and the use of their office. Did the doctor reduce their fee which used to cover such mundane cost of doing business as having an office? Ha! Of course no.

There is simply no end to the greed of the medical cartel hell bent on subverting market forces.

[1] https://www.the-alliance.org/uploadedfiles/Health_and_Wellne...

_ptgt• 8 years ago

While we're sharing stories:

My wife was in a near-fatal traffic accident on 2015 (she was a pedestrian). She spent about a month in the hospital and a month in in-patient rehab. Extremely fortunate for us (and most importantly), she's made a 99% full recovery

She was insured, so that absorbed most of the $1M bill (though the insurance negotiated the bill from the hospital and rehab center to 400k somehow) associated with her care. Several months ago (i.e. 2 years later) we were informed that the insurance company had deemed my wife's last week in rehab "not medically necessary" and refused to pay the rehab center. So the rehab center responded by sending us a $26,000 bill. Due in 30 days lol.

The rehab center is the one who fixed her discharge date (we had no input) and it's not like we're in a position to determine when she's fit to facilitate her recovery on her own. The insurance company still refuses to pay after we called them.

So we're left with a) don't pay the bill and see what happens (credit score hit? Law suits?); b) hire attorneys that will likely cost about as much as the original bill; or c) pay?

Luckily my wife and I have the savings on hand to pay the bill without threatening our livelihood, but is there really no other options for us? How would the average American whose after-tax salary is ~30-40k deal with this?

Btw, if anyone has advice it would be much appreciated. We've talked to some attorneys about Option B but it's uncertain if the cost of retaining a lawyer would outweigh the size of the bill itself.

paxunix• 8 years ago

You can almost always get a free consultation from a lawyer. In that, they will make a guess as to how likely the case is to be won by you (the plaintiff) and decide whether to take it on or not.

It's possible to also have added to the judgement in your favour, coverage for any fees you've had to pay to retain counsel to take care of this legal matter for you.

I'm not sure if by "talked to some attorneys" means a casual chat with a lawyer friend over lunch, or if it means "requested a consultation to determine whether retaining an attorney is the best path forward based on A, B, C".

Call your state's bar association. They can't recommend a particular attorney, but they can generally point you to organizations that can help find the right attorney for you, particularly if cost is a factor.

Will it cost money? Definitely, up front. Will you get it back? Quite possibly.

yardie• 8 years ago

Then what are these additional bills I get from Doctors service companies. I recently paid $250 for an ER visit. That was an expected deductible as outlined in my healthcare plan. What I didn’t expect was a separate bill from the ER doctor for an additional $200 for a 5 minute visit.

itronitron3• 8 years ago

ERs are weird in that people (doctors/nurses) can just pop in and sound like they have something meaningful to say, then disappear 30 seconds later.

During a recent trip to the ER with my son, for abdominal pain, one of the pop in doctors told me that he reviewed the CAT scan and 'her ovaries look good' ... I'm now inclined to write down identifying information with timestamps and summary of interaction for anyone that comes past the curtain.

AnimalMuppet• 8 years ago

I get those, too. I've been somewhat successful at fighting them, though.

FireBeyond4• 8 years ago

Many hospitals like to have their physicians as contractors or consultants.

For bonus points, not all hospitals require their physicians to be in the same network as the facility, so you can get an "out of network" bill for the ER doc at an in network hospital.

Or, to get even more ridiculous, I went to a large chain urgent care. They had labs in house. I got a blood draw there as part of a physical from the PA-C. And an out of network bill. Lab ABC, owned by healthcare provider ABC, inside an ABC urgent care, was somehow out of network, in contrast to the facility and the provider. Cue a $600 bill...

pfisch8• 8 years ago

Procedures can't cost more than the average cost of the same procedure across similar oecd countries.

We pop the corruption bubble and all fights about insurance costs would just disappear because in reality the reason they are so high is because all of this is just a shakedown from the medical/pharma industry.

I'm so sick of this all being framed as a battle over single/multi provider obamacare insurance bullshit when it is really just misdirection and we are being wildly overcharged for services.

It's like we can only debate whether we pay 1000% markup using a credit card, paypal or cash, and not talk about the 1000% markup.

aidenn0• 8 years ago

But where is the money going? I don't know many poor doctors, but most of the ones I do know are not exactly rolling in cash.

itronitron3• 8 years ago

The money is probably going into custom homes, the practice, malpractice insurance, children's education, restaurants, and vacations.

mcny• 8 years ago

But where is the money going? I don't know many poor doctors, but most of the ones I do know are not exactly rolling in cash.

The average debt is reportedly $190k for medical school graduates.

The country should follow N.Y.U.’s lead in recognizing the damage wrought by crushing student debt. Making higher education free for all should not just be a pipe dream.

I don't know how I feel about this. I for one expect people who make over five times our target minimum wage[1] to contribute more through income taxes than they do now. While I agree people at higher levels should progressively pay dramatically more in taxes, if I were to run for political office today, I'd run on the platform of increased (federal) individual income tax for all and an eventual end to all tax credits, deductions, and any such incentives.

How will these high earners pay my demands for a higher income tax if they have trouble paying their loans? I understand that take home pay per month with $180k salary is about $9k per month[2]. Let us say your student loan payment is about $2k[3]. Let us say that your medical insurance and other career related expenses are about $1k. This still leaves you with about $6k per month. Assuming you save half your income (which I hope you do at this income level), you have about $3k a month to spend on rent, groceries, and transit. Assuming you don't have any children and don't have any plans to have any children, this is not a bad spot to be in. Sure, one is not wealthy or financially independent until you are like 65 if you started working at 30, but if one wanted to make money, why is one in the medical field? In my opinion, it is kind of absurd to get into medicine and expect to become wealthy.

[1] Target minimum wage of $15 an hour at two thousand hours a year is $30,000. Five times $30,000 is $150,000.

[2] https://screenshotscdn.firefoxusercontent.com/images/f645f47... https://screenshotscdn.firefoxusercontent.com/images/ecf9387... I initially made the calculation with semi-monthly pay checks which made me doubt my math a little. I have since corrected it to a monthly pay check.

[3] https://screenshotscdn.firefoxusercontent.com/images/61e426e... Interest rates vary but I am pushing for an aggressive twenty year loan which you should be able to refinance when times are good.

https://members.aamc.org/eweb/upload/Education%20Debt%20Mana...

https://www.nytimes.com/2018/08/20/opinion/medical-school-st...

Outline: https://outline.com/Cy2Pdp

Archive: https://archive.fo/dxmZG

analog31• 8 years ago

In my view, the only way to reduce the cost is to figure out where the money is going. Otherwise, everybody can say: "We had to charge $58000 because we had to pay someone else $57000." Right now everybody points to everybody else as the culprit for high health care costs.

A centralized system has a better way of tracking this. If everybody involved with the health care system is working for a government salary, and everybody who sells equipment is selling it to the government, then we know who is getting rich by exactly how much.

AnthonyMouse10• 8 years ago

In my view, the only way to reduce the cost is to figure out where the money is going.

It isn't going to any specific place. The system is designed to destroy price sensitivity, so everything is overpriced and everyone is charged for things they don't actually need.

When there is a bill for $58000, it's not that the procedure costs $1000 and there is this one place receiving the remaining balance we could just cut out. It's that the procedure would cost $1000 only everything that should have cost $20 was charged for $200 and then 500% more steps were performed than were necessary.

Trying to play the blame game is pointless because everyone will come up with a reason to justify their high margin or unnecessary step and the truth is nobody is innocent. What's needed is to actually make purchasing decisions based on price. If one provider charges $58000 and the other charges $56000, the patient should know ahead of time that there is a $2000 price difference, and actually pay the entire $2000 less by choosing the less expensive one.

Do that and there is price competition, and the provider that does the work of eliminating unnecessary costs for you will be the one with the lowest price. And once you have someone offering to do a $1000 procedure for $1000, who is going to pay $58000?

pfisch8• 8 years ago

A centralized system has a better way of tracking this. If everybody involved with the health care system is working for a government salary, and everybody who sells equipment is selling it to the government, then we know who is getting rich by exactly how much.

Did you not see the audit from the pentagon that came out today???

https://www.reuters.com/article/us-usa-pentagon-audit/pentag...

Why would you think they will track things well when they clearly do not.

wstrange2• 8 years ago

Single payer cuts out an entire tier of administrative costs from health care delivery. This is not insignficant.

It also provide more control over wages, drug costs etc. For example, Canadian doctors make less than their US counterparts.

https://nationalpost.com/news/canada/canadian-doctors-still-...

pfisch8• 8 years ago

Here is the main problem with this line of reasoning. Canada is not captured by a huge pharma/medical industry like the US is.

If we do this we will have even less recourse and there will be even less accountability when regulatory capture happens and prices are driven up even higher because all the lobbying money can be focused like a laser now on this one board that we are going to create to manage everything.

The current system is totally fucked, but once the price concerns are made a tragedy of the commons through taxes the medical industry will be able to drive prices even higher just like how the government isn't allowed to negotiate drug prices for medicare right now. How can you not see the insane level of corruption already baked into the system when we have a policy currently where the government can't negotiate drug prices? How fucked up must the system be for that to have ever even gotten to the stage of being considered as a serious proposal, much less implemented?

Without attacking the corruption in the system I just don't think sweeping it under the rug and throwing it on the deficit is a reasonable plan.

fzeroracer6• 8 years ago

Personally, I would gladly take a tax hike to avoid ever having to think about medical bullshit ever again. I don't want to haggle any damn prices for shit that I need and I don't want to have to deal with the corrupt and overpaid insurance industry squeezing me dry. The fact that my family's first response to requesting any sort of aid for their problems is an immediate denial followed by weeks of dealing with paperwork bullshit indicates the system is fucked beyond belief.

We're being wildly overcharged for basic services because ultimately that's exactly how the market is designed to work.

pfisch8• 8 years ago

So you think if we take all these smaller insurance companies and combine them into one large entity that will fix our overpricing problems?

It seems like we will have even less recourse and there will be even less accountability when regulatory capture happens and prices are driven up even higher because all the lobbying money can be focused like a laser now.

I also think the current system is totally fucked, but once the price concerns are made a tragedy of the commons through taxes the medical industry will drive prices even higher.

Without attacking the corruption in the system I just don't think sweeping it under the rug and throwing it on the deficit is a good long term plan.

devonbleak• 8 years ago

Anecdotally I just find it ridiculous that they can't charge me whatever I'm going to owe at the time of the visit. I'm fine paying it then and there, but when you send me a dead tree 3 months later and want me to either send a check or write down my credit card number and send that back forget it - I'll pay you when I see you again.

Seems like a much better solution would be for the insurance to just pay it and then charge me the rest. At least that way I only have one entity to deal with and they probably support online payments. And they're in a much better position to exert leverage to get me to pay - if I'm too far behind on paying them they can suspend my insurance whereas a care provider that I'm unlikely to see for months or years really has no recourse other than sending me more dead trees begging for payment.

hinkley• 8 years ago

Or just be consistent about the bills. If I get a bill for $850 and then another one for $1150 do I owe $1150? $2000? Have you run this by my insurance yet?

So I just wait 60 days and go with whatever the last bill is they sent me. I could do 30 days but I'm already pissed that they can't get their shit together (and at the state of health care) so they can stew for all I care.

darawk4• 8 years ago

This is exactly how insurance and medicine ought to work. The only way we're going to fix the costs in our healthcare system is through high-deductible plans and transparent pricing.

Now, instead of getting paid by insurance companies on a predictable schedule, health-care providers have to engage in an awkward dance. One moment they’re removing a pre-cancerous skin mole. The next, they’re haranguing patients to pay what’s become a growing portion of the total medical bill.

In a situation like that, why aren't they just taking the money upfront? It's not like a skin mole is ultra urgent.

fzeroracer6• 8 years ago

Considering high deductible plans are a scam and part of the reason why we're in this situation in the first place, I disagree.

lotsofpulp3• 8 years ago

High deductible plans are the closest thing to health insurance by definition. Your home insurance doesn't cover routine and expected problems such as roofing replacement or seal coating the driveway. It's for unexpected AND unaffordable damages.

darawk4• 8 years ago

How, exactly, are high deductible plans a scam?

mjevans2• 8 years ago

Healthcare, in America, is broken.

We need single payer healthcare for all emergency and 'standard' care (government gets a bid on rates from practitioners in the area, and if it doesn't like the rate, supports patients via the military systems).

That includes vision and dental; being able to see and being able to consume food properly tend to be requirements for workforce productivity.

Cosmetic and luxury care (like cutting triage lines in non-emergencies) can be premium services.

chrisseaton2• 8 years ago

supports patients via the military systems

Why should the military be involved?

SolarNet• 8 years ago

Author probably meant military health care systems.

maxerickson• 8 years ago

I think they are probably partly talking about VA hospitals, which aren't part of the Department of Defense (the VA is a cabinet level department all its own).

There aren't enough military hospitals to meaningfully support civilians. There's not enough VA hospitals to do it either, but whatever.

mjevans2• 8 years ago

Provider of last resort / "I can do it better"; the argument is generally that private healthcare can do things better/faster/cheaper. So then why not let the infrastructure that serves the active military provide care? Or training for doctors beyond what civilian residency programs provide?

King-Aaron• 8 years ago

cough

Universal healthcare

batiudrami• 8 years ago

In addition to being a more practical solution than what the US has now, it's also just the civilised thing to do. Letting people die or lose their life's savings because they can't afford medical care is some dystopian shit. The very least a government can do is provide its citizens with acceptable medical care.

There is a lot of money in private practice and insurance who are prepared to campaign against reform, however.

koolba• 8 years ago

The problem is nobody has the balls to cut out the corporate tax perks for providing insurance coverage. It’s a local maxima that without a cataclysmic event will not be broken.

AnthonyMouse10• 8 years ago

We need single payer healthcare for all emergency and 'standard' care (government gets a bid on rates from practitioners in the area, and if it doesn't like the rate, supports patients via the military systems).

Look at the other things the government bids on. Are they getting a good deal?

The theory is that the government has a lot of purchasing power and can use it to get a discount, but that's not what happens in practice.

Suppose there are two providers of a service in the area. There are 800 patients and each provider has to capacity to serve 500. If one bids a dollar and the other bids a million dollars, what happens? Both bids have to be accepted, because the first provider can't serve all the patients. Of course, the first provider knows this too, so they both bid a million dollars to begin with.

Compare this with what happens to individuals if we had price transparency: Both providers would rather have 500 customers than fewer, so they try to underbid each other to be the one that gets to fill their capacity. Moreover, individual patients may decide that a significant discount is worth a two hour drive to a neighboring region, so you get inter-region price competition as well. The government can't exactly get away with telling you to drive to the next state or suffer any of the other inconveniences price sensitive customers may prefer over higher prices, so they have to suffer the high bids.

Using the VA healthcare system as an escape hatch is little help because it's just trading one set of problems for another, e.g. the system is very bureaucratic and it can take months to get an appointment. If the government carries through on the threat then the voters would be unhappy and both the government politicians and the providers know that, so it's an idle threat.

lostlogin5• 8 years ago

Look at the other things the government bids on. Are they getting a good deal?

New Zealand has been under a lot of pressure to weaken Pharmac, the national drug purchasing agency, as part of the TPP agreement. It hasn’t happened yet and hopefully never will. The current system is far from perfect but we pay a lot less for funded drugs here in NZ due to Pharmacs bargaining power.

chrisbennet3• 8 years ago

While your argument is well reasoned, you are comparing a hypothetical to an actual one (NZ).

They say one good experiment is worth a 1000 theories. The experiments have been performed, we have the results and they are superior to what we have now.

toomim• 8 years ago

Part of the problem is that hospitals don't disclose prices before performing services.

So patients must agree to a procedure -- yet only afterward find out how much it costs. That price can be shocking, and the patient never agreed to pay it. No wonder it becomes hard to collect from them.

In the rest of the economy, we agree on a price beforehand. That makes customers more likely to pay.

The medical system, however, has given up on disclosing prices to patients, because everything is paid by insurance. And now we have Doctors who say:

“It's harder to collect from the patient than it is from the insurance,” said Amy Derick, a doctor who heads a dermatology practice outside Chicago.

If you want people to pay, then make an agreement with them before you perform the service!

pishpash6• 8 years ago

Exactly. Fed up with being turned into debt collectors? Then don't be shady loan sharks using debt collection as a price negotiation tool.

aczerepinski• 8 years ago

Finding out the price is only half the battle - finding out every doctor who might be involved in a procedure so you can make sure they're in network is the other half. Getting healthcare - even with insurance - can be terrifying.

badwolf• 8 years ago

Gah. This is such a shitty thing.

"Sorry, the anesthesiologist was out of network, though everyone else in the hospital is in network"

sjg0074• 8 years ago

This is not really a thing.

nowarninglabel• 8 years ago

In the rest of the economy, we agree on a price beforehand

This occurs in auto repair as well (though maybe less than it used to). Those repairs, in my opinion, have been quite stressful as well. Are there other industries where we bill afterward?

pishpash6• 8 years ago

It's worse than auto repair since that requires you to give a written estimate and material changes require approval. Healthcare providers will straight up refuse to give any estimate. The galls.

FigBug• 8 years ago

Software Development. I won't do fixed price contracts unless it's really simple. Always time & materials.

Home renovation. You'll get a quote, but the final price can be way higher. Any service when you are dealing with unknowns, the price is going to have to be flexible.

TallGuyShort2• 8 years ago

Maybe find a different shop? I've had mechanics that acted the way described, but I called around and found one that would give me an upfront price for a diagnostic and then called back with a detailed plan for parts and labor to do the required work. I've lived in a number of cities in the US and always managed to find one that does this over the phone.

tomjen3• 8 years ago

I am not even sure doing repairs I haven't agreed to is legal in Denmark, and you can bet I wouldn't pay for them.

Hence my mechanic has my phone number and will call me if there is an issue, and we can agree to fix it (or not, which includes taking it to another shop).

brightball• 8 years ago

The price is also different depending on which insurance company is paying for the service. You’d be shocked to find out the cost of a service if you were willing to pay up front with cash. It’s so much cheaper for everyone involved.

dirkdk• 8 years ago

I once needed an MRI, insurance company couldn't work out a deal before my appointment. MRI company offered to do the job if I paid up front and handled reimbursement myself. Costs up front were $500, compared to $1250 if the insurance company would pay after the procedure. Mind = blown.

sitharus• 8 years ago

I find this baffling. I live in a country with free healthcare but have used private hospitals here in the past. They give an estimate of costs from every practitioner involved before you agree to the procedure. It's not exact but they give a best to worst case range.

I'm not sure how this would apply to emergency care, but for non-urgent procedures I don't see why a quote isn't provided. It feels like a failure of the care providers to me.

almostdeadguy4• 8 years ago

There is no set price for receiving treatment because there are dozens of different systems of benefits and methods of calculating that cost from those benefits, determining eligibility, etc. The private insurer system is demonstrably the cause of the difficulty in determining prices, and the administrative overhead they incur is an enormous part of the cost of healthcare in the US [1].

People don't become debtors simply because they don't want to pay their bills, they become debtors because they can't afford to pay their bills. The number one cause of bankruptcies in the US is medical debt, and no amount of "price transparency" is going to fix that.

[1] https://www.nejm.org/doi/full/10.1056/nejmsa022033

crusso• 8 years ago

Our daughter's doctor recommended a blood test for a possible minor condition she has. We said, sure, without thinking that it was something special. We received a bill for $5k and the insurance only paid $3k of it.

You'd think that for such an expensive test, the doctor or his staff would have a policy of getting our specific sign-off on the cost.

kevin_thibedeau• 8 years ago

The doctor and his staff know how the game is played.

Johnny555• 8 years ago

Part of the problem is that hospitals don't disclose prices before performing services

Even my vet gives an estimate before treatment -- with a "low", "typical" and "high" estimates. I have to sign off on it before they'll provide treatment.

Why can't hospitals do the same for non-emergency care?

jiveturkey• 8 years ago

it would take a month to come back with the estimate. you don’t just call the insurance and get a price.

telchar2• 8 years ago

Often they don't know themselves. It takes an elaborate back and forth negotiation with the insurance company to come to a final cost even when you wind up on the hook for it.

joncp• 8 years ago

The reverse is also an issue. You go to the in-network doctor's office for a routine visit and then get a multi-hundred-dollar bill from their affiliated hospital. So, doctors can't pay their own rent?

sjg0074• 8 years ago

Hospitals != private practice.

rwbt• 8 years ago

In any industry that involves insurance companies predominantly paying bills, will eventually lead to out of control costs (health, auto collision repair etc)

Higher the costs, more incentive (or mandatory) for users to buy insurance and also more profits to insurance companies.

stephen_g• 8 years ago

It's true - a higher proportion of cost borne by insurance companies and the private sector is very strongly correlated with higher healthcare spending - this is from OECD data: https://images.theconversation.com/files/44253/original/3y3h...

Full article - https://theconversation.com/private-insurance-reliance-means...

jld• 8 years ago

I am always amazed at how little of the total bill insurance pays for normal visits. By the time you include copays, coinsurance, and the insurer's negotiated rates, nearly half of what the doctor gets paid is paid by me.

FireBeyond4• 8 years ago

Pretty much. They'll argue that the negotiation is part of the "value" they add, but beyond that in many cases they're merely rent seeking.

Vekz• 8 years ago

Same concerns here. Always left feeling "why do I have to pay this I thought I was insured?". Seems everything has some papercut payment that is un covered

sergiotapia• 8 years ago

Cry me a river. Stop charging obscene amount of money for services.

nickthemagicman2• 8 years ago

I don't know why you're being downvoted. Everyone tries to lay the problems with healthcare everywhere else BUT the actual cost of the service.

My aunt went to the ER for a snakebite. They gave her the anti-venin and let her stay for 12 hours.

It cost 46,000 dollars. It was a rattle snake. They do this thing all the time in India for COBRA bites and it's not even close to being that expensive.

joecool10292• 8 years ago

They do this thing all the time in India for COBRA bites and it's not even close to being that expensive.

US Pharma would say because India doesn't care about medical patents and R&D cost. (Not saying I agree at all, but that's the excuse given)

ucaetano• 8 years ago

Patients are fed up with being turned into money bags

nickthemagicman2• 8 years ago

Does any one else think that traditional capitalism 'supply and demand' doesn't apply to medicine?

Because the demand for your life and health is infinite.

PinkMilkshake• 8 years ago

Every time I read this stuff I feel truly privileged. I'm a New Zealand citizen living in Australia. Not only do both countries have universal healthcare, but they have a reciprocal agreement to provide free healthcare to each others citizens.

Australia has bulk-billed doctors and there's no shortage of them. I can book an appointment online for tomorrow, wait for 10 minutes in a waiting room and see a GP for free. I can even choose which GP I want to see. And I'll likely get anything they prescribe me for free as well. Medicare refunds so much money I sometimes feel guilty because I know I can afford it.

My partner has a chronic health condition that resulted in her large intestine being removed and she requires thousands of dollars worth of medication a month, likely for the rest of her life. We've never paid for surgery or medication beyond admin or prescription fees.

I want this for everyone and I pay my taxes gladly. I would pay more for an even better system. You don't have shit if you don't have your health.

lostlogin5• 8 years ago

I’m pleased you and your partner are getting good care. There have been too many stories recently about how rule changes have completely shafted New Zealanders in Australia. Something is changing - the accelerating rate at which people who can be deported from Australia are shunted out is another part of it.

eriktrautman• 8 years ago

Going to Australia and NZ earlier this year was when I finally had to admit that there is absolutely no justifiable reason why we have such a shitty system in the US. I paid out of pocket for an MRI because it was cheaper than anything I would have gotten in the US with insurance. The end-to-end experience was great.

I returned to find that I couldn't enroll in health insurance until 2019 unless I joined a company as a fulltime employee, resulting in a terrifying 6-month coverage gap where the only option was BOTH paying the lack-of-coverage penalty AND paying for shit "no way they're reimbursing anything" temporary coverage from an agency that didn't even send an insurance card. Our system is undeniably and unjustifiably fucked.

sangd• 8 years ago

"We can't do it for free" but you can't just set any price. I dislike doctors and hospitals for never disclosing the service fee or being truthful about their treatments done on the patients, especially the ER ones. They often perform unnecessary procedures and mark up the fees so high to jack up the cost and settle with a bit less which is still ridiculously high.

joecool10292• 8 years ago

Here's a thought: Maybe doctors should do what nearly every other industry can do. Provide a price quote upfront? I will say there was one circumstance where I received upfront billing without health insurance and that was for a colonoscopy. It was around $2k and they gave a 25% discount for payment upfront. So it's certainly possible for healthcare providers to do this. As I mention below, it's not usually the case:

I broke my hand a little over a year ago during a gap without health insurance. Knowing the ER would start at $1000 for a 'hello' and that I might not have a competent specialist, I decided to take matters into my own hands (haha). First was a call to a friend in Montreal with a sister that's a surgeon. I assessed that while driving to Canada would be more cost effective than a US emergency room, the border might give me issues and followup visits would be troublesome.

So, I walked off the mountain and made a makeshift splint at a Rite Aid with medical tape and a plastic ruler for around $5 ( https://twitter.com/vvtgd/status/879360595526635520 ). When I got back home a few days later I went to a hand specialist, told them I'd pay upfront and had them set it. All in with followups it was around $800.

Initially the specialist's receptionist idiots couldn't figure out how to bill me in person. If you have staff that doesn't know how to invoice a client that pays in cash, you shouldn't be in business. Full stop. Why should a cash paid-in-full client pay more than any other insurance company is beyond me.

Another back on insurance anecdote: I needed an urgent visit not too long ago. PCP wasn't updated on my card, but I did it through health insurance website. Dr still wouldn't accept. Had to pay in person with my CC. Receptionist stole the CC details (it was the only place I used that card for magstripe transaction at in weeks). I needed to get a new card and manually submit the payment details. It's been two months and I still don't have the money back for the visit.

(I'm not going to repeat myself but many years back I also had a rabies vaccination story in which I received almost $20k in hospital bills)

What the above anecdote suggests is that the industry is broken and relies on fantasyland pricing because providers no longer have to compete due to insurance networks. The new hotness is VC's getting into running clinics because as universities can do, they can charge unlimited pricing and force the market to accept it. You don't have an option to barter with health providers, you can't sue them when they are scumbags (because professional protections, etc), and in most situations you don't have a choice whether you get sick/injured... it's just the risk of living.

swagasaurus-rex• 8 years ago

Like college, health care seems better spent outside the US.

kwhitefoot2• 8 years ago

colonoscopy. It was around $2k

What? It takes less than an hour and only two medical people (doctor doing the dirty work and a nurse observing the patient and double checking the video) plus a few minutes to finish the paperwork. The machinery involved is very cheap nowadays and anyway lasts for many thousands of procedures. The consumables are some lubricant, sterilising solutions, paper towels, and something to clear your bowel the night before. At least that's basically what it was like when I had one a few years ago in Norway.

How does that add up to two thousand dollars? Of course I don't know what mine cost because I only had to pay about NOK 250 (very roughly USD 30).

almostdeadguy4• 8 years ago

It's baffling to me that so many smart people on this website don't understand how complex health insurance is or seem to think that people don't pay their bills because they don't like the prices

sumoboy3• 8 years ago

Rich or poor, money is money and if you feel like your getting screwed there is very little reason to feel obligated to pay when due or ever.

almostdeadguy4• 8 years ago

People don't file for bankruptcy to stick it to their hospital, and their hospital isn't putting 7 administrators and clerical workers per 10 physicians on payroll to negotiate repayment and answer questions w/ people who could easily pay their full bill. Let me clarify that I'm not siding w/ the hospitals: you are getting screwed, there's no question about that.

My problem w/ the discourse here is people who treat this like some econ 101 practice problem, when there's no evidence that "price transparency" does anything to address healthcare costs [1].

[1] https://www.nytimes.com/2016/12/19/upshot/price-transparency...

sjg0074• 8 years ago

The real issue here is that HSAs are criminal.. Do not work for a company if the only health insurance plan available is an HSA... unless you are young of course.

pishpash6• 8 years ago

“There’s a burden on both sides,” said Callas. “But health-care providers get caught in the middle.”

Caught in the middle my arse. This is bigly shirking the responsibility and falsely playing the victim. Healthcare providers are extremely well versed in the billing rules and are playing dumb when they pretend not to know. There are literally manuals and seminars on how to bill (i.e. "code") one service as several, or code to a more profitable option when several options are possible, while hiding behind a veneer of respectable neutrality. Multiple large providers have been sued for essentially insurance fraud and go back to doing exactly the same.

It's a big business driven by quarterly numbers and providers don't hire expensive staff to lose at gaming the system. Do you as a patient have a full-time staff to go through billing arcana for you all day? It's impossible to even find a patient advocate. Then on top of that larger providers like hospitals aggressively sell bills to collections agencies on any dispute, abusing the power over the patient's credit as their first resort at price gouging. Thank god for the CFPB and the 2015 credit reporting rule change [1]. The day of reckoning is coming and doctors need a long look in the mirror for why they are in this line of work.

[1] https://ag.ny.gov/press-release/ag-schneiderman-announces-gr...

kleenme• 8 years ago

Am I the only one who finds it strange to hear a doctor refer to a hospital/practice as a "small business"?

bdodge4• 8 years ago

Author of the article here: if anyone wants to talk more about their surprise bills, shoot me an email at bdodge4@bloomberg.net

spectrum1234• 8 years ago

Here's an idea. Make it legal to get lower quality service and pay less. Like every other good and service.

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