Girl’s $143k bill for snakebite treatment reveals antivenin price gouging

https://arstechnica.com/science/2019/04/try-not-to-get-bitten-by-a-snake-it-could-cost-you-143000/

by pseudolus • 7 years ago

193 166 7 years ago

Sahhaese2• 7 years ago

Yes, the US has a messed up healthcare system. It's terrible, but it's not something that tech can fix. It's a political problem, so this is politics and is disappointing to see politics at top of HN.

bilbo0s• 7 years ago

so this is politics and is disappointing to see politics at top of HN..

Huh?

There's always politics at the top of HN.

Retra3• 7 years ago

Political problems are mostly communication problems, and communication is tech.

jsloss• 7 years ago

Can you expand on your point? Because it makes no sense to me.

dkersten2• 7 years ago

HN isn't a tech-only place. There's plenty of politics, business & investment (with an emphasis on startups for obvious reasons) and other non-tech topics here all the time.

Sahhaese2• 7 years ago

From the news guidlines:

Off-Topic: Most stories about politics, or crime, or sports, unless they're evidence of some interesting new phenomenon.

I'd like to hear you out if feel this is a new or interesting phenomenon.

crehn• 7 years ago

HN isn't only about tech.

maxxxxx3• 7 years ago

A lot of people here try solve problems by starting companies or creating technology. So instead of solving the "problem" of serving more ads like a lot of the best tech people do at Google and Facebook I am happy that the people here care about this very real problem and hopefully some of us will do something about it.

josefresco3• 7 years ago

This again? Why doesn't anyone read the guidelines, or see the 1 million other posters who ask this same question, only to be corrected and sent a link to ... the guidelines!

https://news.ycombinator.com/newsguidelines.html

Maybe I'm old and grumpy, or maybe I've been on HN too long but this comes up waay to often. /rant

detaro2• 7 years ago

The poster had addressed that already: https://news.ycombinator.com/item?id=19797003

nthompson3• 7 years ago

Buddy of mine breaks his collarbone, gets some pins put in. They drop him a bill for $25k.

He says "I'll give you $1500 now, or you can send me to collections."

They took it; now I use this technique all the time.

They make up a number which is how much they hope to get out of you, and you should return the favor by make up another number. Then scream at each other on the phone for a few hours before coming to terms.

Sad that it's come to this, but medical billing is a shell game. You can play it too.

microcolonel• 7 years ago

Sad that it's come to this, but medical billing is a shell game. You can play it to.

All irregular billing is a shell game.

dekhn2• 7 years ago

Thank you for pointing this out. I really hate articles that treat the rack rates presented to uninsured consumers as a fixed bill; it's not. I think this is something where articles could do a better job of explaining to readers how the rates are really an opening to negotiation (the negotiations already done by insurers).

vlunkr• 7 years ago

The problem is that it’s not presented as a negotiation to consumers. Negotiation/bartering are far from the norm in our culture.

dugluak2• 7 years ago

We were charged $9000 for epidural during our first child's delivery. After a lot of back and forth between me, the hospital and the insurance company I ended up paying $99. I never tried to understand the logic.

snarf212• 7 years ago

The logic is that anyone who does pay makes them a ton of money.

empath753• 7 years ago

I had two insurance companies when our first kid was born, and the hospital completely botched the filing leading to both companies denying the claims because of late filing and so on (we gave them additional the info they needed a few days after the initial claim was denied — they didn’t refile until nearly a year later).

They tried to come after us for 10s of thousands of dollars in bills.

After much back and forth with insurance companies and the hospital most of it was either discharged or paid for by insurance, they eventually sent us to collections for $1000.

Unfortunately for them, I had been taking detailed notes of conversations, including people I talked to and dates and times, and had gone through itemized bills, noting things like duplicate charges, and multiple times I had been lied to on the phone by the billing department about what paperwork they had filed with the insurance companies and when along with documentary evidence by the insurance companies.

By my reckoning they actually owed me an $800 refund from a check I had sent them earlier to cover a charge that an insurance company later paid.

I said if there isn’t a check in the mail today for $800 and the collections notice retracted, I’m taking all this information and filing in small claims court.

It was taken care of that day.

My kid was already walking by the time the billing was handled for his birth.

It’s so depressing because as a hospital, we have absolutely no complaints about the care. It’s hard to believe that they can be so competent at delivering care and so completely incompetent at billing for it.

jokoon• 7 years ago

Won't the healthcare market fail at some point if this keeps going on? I mean there might be some big loan somewhere that will default one day. No idea what will happen then.

kemiller2002• 7 years ago

There is a whole lot of accounting magic, and forecasting that goes on. They know that they won't get a lot of it, but there are several things they do to "mitigate" their "loss". They get to write it off on their taxes. They'll often sell unpaid debts to 3rd party debt buyers. They'll get some money out of bankruptcy etc.

cbm-vic-20• 7 years ago

That depends on how much it actually costs to deliver their services, in aggregate.

barry-cotter• 7 years ago

What market? If you get problems from regulation and the solution is always more regulation you eventually get a Rube Goldberg state run health system. If the US wanted cheaper medical care they could disaggregate medical care and actually try to drive down costs. As it is the supply of people who want to be doctors just keeps going up and there are plenty of foreign doctors who would be delighted to work in the US who aren’t allowed to do so. The AMA doesn’t want nurse practitioners and it doesn’t want foreign doctors and they’re winning. Hell, look at India, they have something close to a free market in medical care and factory line hospitals where people get better at the procedures they do by doing one thing many times and list prices. Why can’t the US do that?

https://www.chrisstucchio.com/blog/2015/medical_tourism.html

One of the things I like most about India is it's medical system. As an American, I've experienced both the Indian and US medical systems, and at this point I have a very strong preference for the Indian one. Somewhat surprisingly, the Indian medical system is based on free market capitalism, and as a result it tends to provide a much better experience than the US system.

will_brown4• 7 years ago

They took it; now I use this technique all the time.

I’ve done this once for a $12,000 bill for a few stitches. They refused any deals, until I showed I actually took video of hospital staff promising it wouldn’t be more than $2,000 before treatment, in response they waived the entire bill.

The way you phrase this though...how often are you receiving acute medical treatment?

caprese• 7 years ago

I should do that

Everytime some staff member says "it will be covered we are just doing x, y, z this is covered"

and then you get a bill from the insurance company and the doctor's office says "we THOUGHT it was covered"

webdevmark• 7 years ago

As a British person living in the UK reading stories like this seems so crazy. The very idea that when Americans are ill they need to negotiate with these huge institutions seems so utterly bizarre and messed up.

Surely if people know they could be fined thousands for simple treatments like stitches they avoid medical care altogether? Then things could get worse and even more expensive...

jopsen• 7 years ago

The way you phrase this though...how often are you receiving acute medical treatment?

I was unable to a price quote of any kind before elective procedures, when I lived in the US (last year).

My insurance was good, but they would not say if they would cover the bill ahead of time.

hombre_fatal3• 7 years ago

I live in Mexico and have had to get stitches many times. Paid $4 per stitch in the private hospitals in Guadalajara. I paid $24 in cash with the pesos in my pocket and walked home.

Even the dentist system in Mexico is walk in, pay, walk out for high quality work. I tried to go to the dentist when visiting family in Texas and had to fill out paperwork and pay to be a member first.

Seems like the only benefit of the US system is when you have a nice job, everything is basically free. Probably why nothing will change too much anytime soon. To quit your nice job to try to start a business forces you to gamble with your healthcare.

jaunkst• 7 years ago

Yikes. Think I'm going to learn to do my own stiches.

maxxxxx3• 7 years ago

In what way are these guys different from mob guys running a protection racket? They seem to operate exactly like thugs that come to a restaurant, ask for money for "protection" and then often walk away with 10% or less of what they asked for.

fma• 7 years ago

If mob guys lobby politicians to make their protection racket legal, then no difference.

YeahSureWhyNot• 7 years ago

they will probably still send him to collections, just later. thats what happened to my friend who needed surgery on his hand.

nthompson3• 7 years ago

Yeah, but medical bill collections has way less weight on your credit than (say) a car bill past due.

They send so many people to collections that even creditors don't care about it anymore.

tombert2• 7 years ago

About ten years ago, my wife had to get her gallbladder removed; they had a bill of $75,000. Her family was very poor, didn't have insurance, and they similarly made an ultimatum of "you can either get nothing from us, or you can get $5000", which the hospital accepted. $5000 was of course still a struggle, but how absurd is it that they were effectively doing a 1500% markup for a life-saving procedure?

If they hadn't known about this trick, there's a good chance that her family would have had to declare bankruptcy to pay for this, which of course means that the taxpayers are stuck footing the full bill.

mixmastamyk2• 7 years ago

Well, they took some amount that covered their costs. It's not clear they made a profit or not. They know some will not pay and pass the cost onto the rest of us.

ticmasta• 7 years ago

Do most hospitals run billing systems supplied by Oracle? That would explain this "size-'em up" pricing strategy...

Broken_Hippo• 7 years ago

This seriously can backfire, though. The hospitals where I lived... they took folks to collections. They would take you to court for a fairly low amount of money and garnish your wages. Sure, it takes longer, but they'll get their money. IIRC, in the state I lived in, they can take 25% of your pay as long as they leave you an amount equal to 30 hours at minimum wage.

It generally just takes years longer.

Buttons840• 7 years ago

How can you avoid the "backfire" of having to pay the whole bill? Just pay the whole bill straight away?

People should be honest and pay reasonable bills. But forcing collections and/or lawsuits is one way to put on display for everyone how bad our medical care charges can be.

cosmie• 7 years ago

When using the technique, be sure to get confirmation in writing that the bill is paid in full.

I've used it twice before. Once the hospital offered to consider it paid in full if I paid my entire $500 copay at time of discharged (i.e. anything left after copay + insurance payment would be written off).

The second time, I was able to get a facility fee negotiated down from $5k to $1k. The $4k difference found it's way to debt collections and onto my credit report due to the way the payment was written down in the system, and it was hell getting it dealt with since I didn't have explicit confirmation that the $1k wasn't a partial payment on the full bill.

Abishek_Muthian• 7 years ago

Living in India, near Western Ghats being bitten by snake is one of the constant worries due to availability of anti-venom at the nearest medical center (Which usually is state run hospital usually located in the centre of the city). But if one is lucky to make it to the hospital, being state run, the cost of snake bite treatment isn't prohibitive.

But as with other health care related expenditure in US, snake bite treatment seems just as messed up.

lr4444lr• 7 years ago

When KHN questioned St. Vincent Evansville hospital on its charges for Crofab, the hospital noted that the snake-bitten girl’s family wasn’t on the hook for the bill. Insurance covered the price of the antivenin. And, in the end, the family’s insurer negotiated the $67,957 antivenin bill to $44,092.87.

So it wasn't the girl's bill, it was the insurance company's. What would they have charged the family if they were poor and uninsured? Probably a lot less than even what they settled with the insurance company for. Yes, U.S. healthcare is screwed up, but I don't think this case resembles what happens to people who actually falls through the cracks.

electriclove2• 7 years ago

'What would they have charged the family if they were poor and uninsured?'

Probably a lot more

nthompson3• 7 years ago

Do you work in medical billing? My experience is just the opposite, they try to extract marginal costs from those people.

TheCondor• 7 years ago

Can they somehow extract this back as a tax deduction? The parties are remarkably willing to negotiate, whereas your mortgage provider won’t move very far at all if things get sideways. If they aren’t, I’m certain there are ways to financially engineer things to recoup at least some of the “loss.”

nradov• 7 years ago

Most US taxpayers can deduct medical expenses which exceed 10% of their income (subject to some limitations).

rand0mthought• 7 years ago

This can be tax deductible if you use HSA (Health Savings Account)

projektfu• 7 years ago

They would have listed a charge for at least $67,957 if that's what they were tendering to the insurance company. Uninsured people do not get negotiated rates which are usually discounted. The final bill might have been lower if they negotiated. A lot of hospitals will lower the bill and then include that number in the amount of "charity" care they provide.

js2• 7 years ago

This article is part of a “bill of the month” series between NPR and Kaiser Health News:

https://www.npr.org/sections/health-shots/2018/02/16/5855495...

Entire series:

https://www.npr.org/tags/585747919/bill-of-the-month

I think a handful of these have had significant HN discussion, but this is the only other one I can find at the moment:

https://news.ycombinator.com/item?id=18328934

estebarb2• 7 years ago

Meanwhile in Costa Rica the treatment for even more poisonous snakes would cost zero dollars with zero zero cents (including helicopter or small plane, if required). Here antiofidics are produced by the Universidad de Costa Rica, and every public health center has a reserve of it. Those serums are exported too. I really can't understand how USA got public health so wrong. Here we pay like 9% of tax over salary and get "ALL the health cover you may need": broken legs, cancer, HIV, transplants... You name it: each and every treatment is free: no deductible, no coverage limits, no contractual exceptions, no preexisting conditions, not even a call to the insurance company before receiving treatment or having to provide your ID. Sometimes I had thought about applying to a cool techco at USA, then I remember the health system differences and I forget it.

commandlinefan• 7 years ago

But that's even worse - now the $143k bill is sent to the government which just shrugs its collective shoulders and pays it... until the money runs out.

plasma• 7 years ago

As an Australia who enjoys universal healthcare, not once have I ever worried about being sick financially and how much it would cost me.

I can go to any doctors I want and easily afford the medication I may need, and may visit a doctor preemptively and without worry about cost.

It saddens me that American citizens are suffering with such an awful healthcare system, and no where in the galaxy would I ever wish a system like yours to enter Australia.

You should vote for universal, single payer healthcare.

Scarblac• 7 years ago

Why would there be a $143k bill at any point? You only get that if there are profit-maximizing companies in the supply chain.

twiss• 7 years ago

That's not what happens in practice - a government has a lot more negotiating power, and less skin in the game, than individuals who need the treatment. Governments can and do sometimes refuse to pay treatments that are too expensive. This may cause citizens who want that treatment to be upset, but for 99.99% of treatments it leads to them being a lot more affordable.

estebarb2• 7 years ago

Not really: hospitals are public, and doctors are on government payroll, which keeps their prices on check. For example, a similar emergency here would cost nothing to the patient, and less than $2500 to the public health system (mostly helicopter gas): more or less $0.001/tax payer. Costa Rica has around 1000 cases like this per year, so state of the art snake poisoning treatment coverage costs less than $1/tax payer/year (most cases doesn't require air transport).

The public health coverage covers everyone depending on the worker so the system receives money (from salary taxes) proportionally to the amount of people it has to cover (think of it like a non for profit health insurance company).

A nice result is that competition from government keeps private sector prices low, and more or less still accessible to most population. That is why here private hospitals are profiting from medical tourism.

grey-area• 7 years ago

Other countries spend substantially less on healthcare, not more.

Youden2• 7 years ago

You make it sound as if single-payer will lead to higher costs but that's demonstrably not the case. Look at the OECD healthcare spending, which includes both government and individual expenses: https://data.oecd.org/healthres/health-spending.htm

The US is over 2x the average with its free for all system while the single payer countries all pay substantially less.

conanbatt5• 7 years ago

What foreigners with socialized systems dont understand is that financing is not the same as cost.

The us has individual financing and high cost. The industrialized world has medium-high cost and no individual financing. Third world countries have no individual financing and low cost.

Individual financing does have an impact on cost, but thats not what makes healthcare in the US expensive as a whole. Its a combination of regulatory capture and subsidies and regulation. And the public is also very responsible for such a system because americans are very averse to sub-standard care.

sorokod5• 7 years ago

How does any of this explain haggling over a medical bill?

Youden2• 7 years ago

The us has individual financing and high cost.

I think that's quite an understatement given total healthcare spending in the US is over 2x the OECD average: https://data.oecd.org/healthres/health-spending.htm

drb912• 7 years ago

Well McCarthyism removed just about everyone who would have fought for public health care in the 60s with the rest of the western world.

ptah• 7 years ago

kaching

h2odragon• 7 years ago

Had she been bitten by a venoumous snake? TFA says "Thought to have been a copperhead"... They don't always use their venom. My dogs kill a few every year, they've had a couple bites but nothing serious. On the other hand I've lost several dogs to moccasin bites.

They're not hard to distinguish from other snakes, but then again, how many people saw that snake, had they any experience identifying snakes, etc.

Surely they wouldn't go shooting up someone with anti-venoms until they determined whether it was necessary?

kaitai2• 7 years ago

I'm not sure about that. Trying to find the article... but rabies shots, for instance, are very expensive and prescribed on a population level far out of proportion to the risks. Right, here's one such article (it's a county-wide review of prescriptions, not a huge study): https://www.seattletimes.com/seattle-news/health/half-of-peo...

caffed• 7 years ago

Why would transportation cost 55k+ to begin with?!?!

post_break• 7 years ago

I was in an ambulance. The bill was over 20k. This is a glorified RV. I can’t believe the helicopter was only 55k.

mnm1• 7 years ago

If companies can outsource jobs to other countries, we should be able to import drugs from other countries in the same way without restrictions. It's ridiculous that this isn't the case. This for profit drug and medical industry in they US needs to die. One way that could be achieved is by having a single payer system that negotiates prices. Don't want to agree to the new, reasonable prices? You don't get to participate in the system and therefore most patients will not be your customers. It's tiring living in a supposedly developed nation that doesn't even have proper healthcare. That's not developed at all and as Americans we should be ashamed of our healthcare system that prioritizes profits over health and lives.

tathougies• 7 years ago

So this seems to me to be an instance of the system working. For example, the girl's family wasn't actually charged. The article notes the insurance paid for it. Keeping the price high here helps the hospital cover the costs of people who cannot afford treatment (I don't think this is a good sign, but it is how our system works).

The article also notes that due to competition, the price of the medication is now significantly lower. I guess I don't really see the issue here. This is to be expected... if there's a cheaper drug produced elsewhere that works the same, then it will become more used.

Avshalom• 7 years ago

keeping the price high is why people cannot afford treatment.

bg4• 7 years ago

They tried to charge me $7500 for a few stitches on my son's chin when he fell at preschool. Outrageous.

Girl’s $143k bill for snakebite treatment reveals antivenin price gouging

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