Your New Medical Credit Score Could Deny You Care

https://thetoolsweneed.com/poorly-secured-medical-credit-score-could-deny-you-care/

by kaxline • 6 years ago

337 385 6 years ago

thathndude• 6 years ago

The score would almost certainly qualify as a credit report that you are guaranteed access to buy the fair credit reporting act. Pretty much, this article gets the facts wrong in the first two sentences.

SolaceQuantum7• 6 years ago

So, where do we buy our medical credit reports?

techntoke• 6 years ago

The dark web

hedora2• 6 years ago

I doubt it. The hospital isn’t extending an offer for credit, so the law probably doesn’t apply.

Also, from personal experience, the FCRA reports are useless.

The credit reporting agencies report completely different scores to consumers than banks, and give false information about how to increase your real score.

In particular, doing things that benefit banks (such as opening more credit cards) increases the consumer visible scores, but not the scores used in many real estate transactions.

The entire credit reporting industry should be outlawed.

If I owe you money and won’t pay, sue me. If you want to gauge my credit worthiness, look at my income, and check for court decisions against me.

the_svd_doctor• 6 years ago

FCRA doesn’t only apply to credit but also housing and employment for instance. I din’t know wether it applies to healthcare though.

tialaramex• 6 years ago

Two things, having worked for a big Credit Reference Agency although not specifically on consumer credit.

1. The commercial customers can (for a fee of course) arbitrarily customize the metrics they care about. If you're looking for customers for your high APR "accept anyone" card you don't actually want the person with a squeaky clean history who'll never incur interest. But the recommendations do correlate pretty well with getting what most of us would consider better credit. Lower rates, better terms.

2. The CRAs grew naturally out of what happened before this data was available. Experian, for example, is essentially spun out from a mail order catalog company. So what your plan does is just waste everybody's time for a decade or two and then we're back here again but meanwhile the poorest people have no access to credit.

JohnFen9• 6 years ago

The hospital isn’t extending an offer for credit

That's exactly what the hospital is doing when it doesn't require payment at the time services are performed.

uoaei13• 6 years ago

You may not like it, but this is what peak private-markets-for-public-goods looks like.

rayhendricks• 6 years ago

I’m just waiting for experion to get hacked again and all this info to be public.

52-6F-622• 6 years ago

That was my first thought—then I recalled, "no that was Equifax, wasn't it?"

Sadly, no. It's been all of them, including Experian. This seems flat-out mad to me.

https://www.theguardian.com/business/2015/oct/01/experian-ha...

marriedWpt• 6 years ago

Can we call it a cartel market instead of private markets?

The various healthcare leaders use their wealth to strengthen their position through laws.

Most sectors cannot operate like US medical, they are their own beast.

TeMPOraL2• 6 years ago

The various healthcare leaders use their wealth to strengthen their position through laws.

Everyone who can does that. Laws and politics aren't a separate magisterium from business; there are no hard borders here.

cwzwarich2• 6 years ago

Isn't it natural to want to only "sell" to "customers" that are profitable? This is a natural function of other markets.

Analemma_2• 6 years ago

Which law specifically permitted this behavior, and under what laws was it illegal before that?

Joe-Z• 6 years ago

Maybe finding new ways for the market isn't the best approach. What about publicly shaming the people who profit off of this?

I remember there was a big outrage about Martin Shkreli's actions. Meanwhile the CEOs of these companies probably get lauded in business magazines.

Calling these miserable, greedy, selfish bastards out for what they are could be a first step. God, how I'm hoping for a socialist revolution to take place within my lifetime...

thisisnico2• 6 years ago

So absolutely happy to be Canadian.

Santosh83• 6 years ago

Eventually coming to all countries as the elite in power are falling for the prospect of huge money...

tryptophan• 6 years ago

'public good' doesn't mean 'thing I want the government to give me'. Your sentance is complete edgy nonsense.

https://en.m.wikipedia.org/wiki/Public_good

seneca• 6 years ago

For those who don't know the definition:

"In economics, a public good is a good that is both non-excludable and non-rivalrous"

"A good is considered non-rivalrous ... if, for any level of production, the cost of providing it to a marginal (additional) individual is zero"

"... a good or service is non-excludable if non-paying consumers cannot be prevented from accessing it."

criddell• 6 years ago

You know what he's saying though.

uoaei13• 6 years ago

I suppose "public service" is technically the more appropriate term. But it is a public benefit in the sense that healthy people can contribute more to a healthy economy.

raxxorrax• 6 years ago

But otherwise I could be made responsible to pay for that other poor soul, the concept of risk distribution is too complicated and strokes of fate never touch me.

Mirioron3• 6 years ago

The issue in the US seems to be that even if you have a decent insurance plan you can still easily end up getting treatment by someone out of network. An anaesthesiologist or similar.

SkyBelow5• 6 years ago

How so? Last I checked there are massive laws about who can open a hospital, who can operate as a doctor, who can sell what kinds of insurance, who can sell drugs, and what can be sold as a drug. This is government granted oligopoly.

Edit: Technically oligopoly, not monopoly, though it may tend towards one.

uoaei13• 6 years ago

The logical conclusion to private markets + unrestricted lobbying + Citizens United. They literally made the laws that restrict competition. They were only capable of this because of the insane amounts of profit they extracted from an otherwise public service, which they spend on schmoozing lawmakers.

fennecfoxen2• 6 years ago

Nonsense. A public good is something that doesn't run out when more people use it, such as knowledge. Medical care makes use of limited resources such as drugs, hospitals, doctors and nurses.

waffle_ss3• 6 years ago

What I don't like is low-effort memespeak on HN (even if I agree with the sentiment). This is one of the last places that has kept that at bay - until recently.

adambyrtek• 6 years ago

From the HN guidelines:

"Please don't submit comments saying that HN is turning into Reddit. It's a semi-noob illusion, as old as the hills."

Yes, I can see that your account was created in 2011 :)

zionic• 6 years ago

Seems like proper application of the downvote button is called for.

uoaei13• 6 years ago

I think one-offs like this are ok, and I'd like to think mine was a step above "low-effort" ;) Besides, check out the discussion it spawned!

It's those long chains that end up being an out-of-order recital of some famous TV/movie scene that really irk me, personally. Those and similar are cases where the value is only in recognizing the source and getting that dopamine hit, and not in any further contribution to the discussion.

merpnderp4• 6 years ago

Peak? This is the most heavily regulated market in the US, and fully 40% of all medical spending is from federal, state, and local governments.

This is peak political corruption.

unishark5• 6 years ago

I have seen estimates that as much as two thirds of healthcare spending actually traces back to the govt when you count subsidies too. It is a mostly-socialized system at this point.

And of course even where the govt is not funding the product, they are stipulating in detail what it must include. E.g. insurance must include a long list of things from mental health care to nicotine patches, forcing people to go through their insurance rather than through a market where they would negotiate prices.

privateSFacct• 6 years ago

Huh? Medicine is highly regulated. If this was a market you would have hospitals posting prices and negotiating with customers directly on price / quality.

Instead health plans market to EMPLOYERS (not the consumers of the actual product). Trust me - the service there is pretty amazing! Tax law is designed to in many cases benefit these employer negotiated plans.

uoaei13• 6 years ago

The market conditions as they stand today were constructed by the participants in that market. This is an outcome that one can reasonably expect, since lawmakers can be bought and a large proportion of health services are pretty much completely inelastic.

dang2• 6 years ago

This comment broke the HN guidelines by taking the thread on a generic ideological tangent. Those are predictable and boring, and lead to flamewars. Please don't post them here.

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

uoaei13• 6 years ago

What is the line between policy tangents and ideology tangents?

exdsq2• 6 years ago

I like how they reference this post alongside their Reddit posts but as of now it's just people commenting saying the author has it wrong. Awkward.

alexpetralia• 6 years ago

To be fair, isn't that type of criticism exactly the thing an open discussion board is meant to encourage?

gatherhunterer• 6 years ago

He’s lying. There is only one such comment and it is laughably obtuse. Influencing opinion without addressing the topic is exactly what Reddit is for.

hedora2• 6 years ago

I’m surprised this doesn’t violate HIPPA or CCPA.

Every time you visit the doctor, the hospital tells experian (by querying the experian system) and then experian resells this information for profit.

prostheticvamp• 6 years ago

HIPAA does not preclude hospitals from sharing data with business partners as needed to conduct their business affairs, assuming those partners likewise comply .

inetknght• 6 years ago

sharing data with business partners as needed

"As needed" is a definition that most patients would disagree with

gen2203• 6 years ago

IANAL. It is not a HIPPA violation if Experian has signed a BAA with the hospital. It's on the hospital to perform the due diligence checks, to verify that Experian's capable of upholding the terms of the BAA.

This article talks about how Experian have SOC-2 issues, which is a cause for concern, but smaller hospitals with tighter budgets could be inclined to look past it.

In general, it's important to understand that HIPPA doesn't prevent data from being shared, it gives it a legal framework to be shared within. When things go bad, the HIPPA-associated paperwork provides a roadmap for assigning liability.

Liability does get assigned, and companies (providers, insurers, network providers) are held responsible, despite the popular imagination: https://ocrportal.hhs.gov/ocr/breach/breach_report.jsf

throwaway57522• 6 years ago

Minor point, but it's HIPAA with two A's, not two P's.

HIPAA pertains to PHI and PII (protected health information and personally identifiable information, respectively). The fact of your office visit is not either of those if it's not linked to health information (labs, medical records, notes, itemized bills).

Further, it may be allowed under permitted uses and disclosures as-is, without authorization under the language for payments. I couldn't tell from the article, but the health systems could simply decline to treat you without your authorization for the credit check.

Separately, people love to make healthcare into the bad guy, but it's not a monolith and there are hospitals closing down because they are losing money. There is a systemic problem in the US here, and I bet this is those 2nd/3rd tier markets in smaller systems that can't absorb defaults like nationals can.

jdmichal• 6 years ago

HIPAA pertains to PHI and PII (protected health information and personally identifiable information, respectively). The fact of your office visit is not either of those if it's not linked to health information (labs, medical records, notes, itemized bills).

False. Directly from HHS, emphasis mine:

https://www.hhs.gov/hipaa/for-professionals/privacy/laws-reg...

“Individually identifiable health information” is information, including demographic data, that relates to:

* the individual’s past, present or future physical or mental health or condition,

* the provision of health care to the individual, or

* the past, present, or future payment for the provision of health care to the individual,

Spooky235• 6 years ago

HIPPA protects you from gossipy front desk people. The rest is a joke.

Your prescriptions, hospital admissions, radiology orders, etc are in the hands of any of a dozen third parties before your claim is processed. It is trivial to un-anonymize the data.

SolaceQuantum7• 6 years ago

"Private hospitals are now consulting a secret medical credit score from Experian before you even see a doctor. As a patient you do not have access to this score, nor can you see how it is generated. All you know is that you may be denied care, or receive different care, because of it."

Could we classify 'not being able to afford, either time wise, emotional labor wise, or money wise, to deal with the messed up medical billing system' as a pre-existing condition?

aldoushuxley001• 6 years ago

Well that's terrifying

IHLayman• 6 years ago

It’s not just Experian... TransUnion has it too, with the same name as a matter of fact. Although it looks to be a report and not a score just yet, unless I didn’t read it correctly: https://www.transunion.com/product/patient-financial-clearan...

Analemma_2• 6 years ago

The one bright spot to this is that, since it's a ratchet that can only go in one direction and find more reasons to deny people as it gets more data, privatized health care will eventually be its own undoing when enough people are frozen out of coverage that they can form a voting bloc and give this system the bullet to the head it deserves.

magduf5• 6 years ago

Considering how much of the population keeps voting for this system, I don't see that happening for decades at the least.

marklacey• 6 years ago

The Financial Clearance system combines medical records along with the financial records Experian already has on you to calculate the score.

How is this not a complete violation of HIPAA?

Are they working around it by having very general HIPAA release forms?

ceejayoz11• 6 years ago

The law explicitly permits sharing with other entities for billing purposes.

https://www.hhs.gov/hipaa/for-professionals/faq/268/does-the...

The Privacy Rule permits covered entities to continue to use the services of debt collection agencies. Debt collection is recognized as a payment activity within the “payment” definition. See the definition of “payment” at 45 CFR 164.501. Through a business associate arrangement, the covered entity may engage a debt collection agency to perform this function on its behalf. Disclosures to collection agencies are governed by other provisions of the Privacy Rule, such as the business associate and minimum necessary requirements.

filereaper• 6 years ago

As a Californian resident, how does stuff like this not violate CCPA?

Brokers reselling my health info is far more critical to me than my buying habits.

Is there a "do not sell my health info" checkbox?

jhart99• 6 years ago

According to Experian, it looks like they claim they do not collect medical or health information on California Consumers. https://www.experian.com/privacy/ccpa-privacy-policy.html I would love to send them a request to see if that is in fact true.

FireBeyond5• 6 years ago

Is there a "do not sell my health info" checkbox?

Yeah, except, sadly, it'll most likely be "You're welcome to try the hospital across town if you'd like...".

alberth2• 6 years ago

I’m confused, so what exactly do the hospitals want to gain from this “medical” credit score?

If the hospitals simply want to gain insight on your ability to pay your medical bills, wouldn’t your “normal” credit score be able to provide that insight.

What’s different between your “medical” credit score and your normal credit score?

Edit: Additionally, there are laws in place in the US that state in emergent situations, no hospital (public or private) can deny care - regardless if you can pay or not. So the article title might be a bit sensationalized.

SolaceQuantum7• 6 years ago

It is possible that in non-emergency situations, the vast majority of situations, a hospital may deny or change the quality of care based off of your likelihood of paying it off. No one knows the difference between a "medical" credit score and a normal credit score, but we do know that this special, secret credit score is being used to calculate patient treatment.

alberth2• 6 years ago

Wouldn’t the easier solution be to not accept patients without insurance (and low co-pays).

And given that it’s now a US requirement to have medical insurance, I’m still struggling to understand what this medical credit score is accomplishing.

ryandrake2• 6 years ago

Nit pick, but I think the word you two are looking for is “emergency” rather than “emergent”.

adrr2• 6 years ago

Standard Credit scores are more lenient for medical debt. It takes 6 months for unpaid debt to show up and fully removed if paid in full even after it is sent to collections.

huebomont• 6 years ago

I believe medical debt is no longer allowed on credit reports now. Maybe this is to get around that?

toomuchtodo• 6 years ago

"Specifically, the NCAP prohibits adding medical debt to credit reports until after 180 days from the time the account was reported to the credit reporting agency. It also mandates the removal of previously reported medical collections that have been or are being paid by insurance." [1]

Medical debt can still be added to your credit report.

[1] https://www.creditkarma.com/advice/i/how-to-remove-medical-c...

pulse7• 6 years ago

In Switzerland private hospitals will calculate the possibility of success in your case and if it is too low you will not be accepted, because they want to keep their success rates high... Maybe such "Medical Credit Scores" could be used for the same reasons...

pbrb• 6 years ago

I'm with you, not paying medical bills affects your credit score the same way as any other bill. To me, it seems like it's just another service for the credit unions to make money on, while giving private hospitals some legal protection.

Really, it's disgusting.

metalliqaz7• 6 years ago

s/credit unions/credit reporting agencies/

credit unions are one of the few pro-consumer entities in the financial world, it would be a shame to smear them

avgDev• 6 years ago

It is not exactly the same. The bill cannot go into collections for 180 days. This is different from regular debt.

kickopotomus• 6 years ago

Medical debt is regarded less harshly in FICO 9. I am not sure how widespread the use of FICO 9 is currently among credit bureaus but it is the latest standard.

kkotak• 6 years ago

I bet 'Likely to be litigious' score is part of that Score. Physicians and hospitals would kill to see such a score before they start treating new patients

iamnothere2• 6 years ago

Edit: Additionally, there are laws in place in the US that state in emergent situations, no hospital (public or private) can deny care - regardless if you can pay or not. So the article title might be a bit sensationalized.

This is true, but many life-saving treatments (such as chemo or radiation treatment for cancer) are not "emergency" treatments, despite being necessary and somewhat urgent.

JohnFen9• 6 years ago

The legal obligation hospitals have is that they must treat you if you are have a life-threatening emergency happening. That treatment can be the minimal amount needed to stabilize you so that you aren't at immediate risk of death. There is no obligation to treat you beyond that, nor to engage in follow-up care.

throwawayhhakdl• 6 years ago

I think you’re viewing the problem backwards. It’s not that they intend to send out a standard bill and know in advance who can pay. It’s that they intend to send out bills scaled to people’s ability to pay.

It’s probably more profitable for them to send a small bill to a poor person than a large bill that is never collected. It’s definitely more profitable to throw the most ludicrous bill at those who can and will pay whatever cost is sent at them. You can also adjust the kinds of treatments given according to likelihood of profit.

I wouldn’t be surprised if the latter case is illegal (or happening or not). I’m pretty sure the former case is perfectly legal, though symptomatic of a bigger problem.

logfromblammo• 6 years ago

They might want people to be afraid that if they don't pay their bills, they might die. Since the threat of debtors' prison is no longer viable, I guess.

Moves like this erode my opposition to nationalizing the entire US health-care sector. If they're going to cartelize or confederate, patients--which is to say everyone in the country that lives and breathes--will also want a seat at the table.

From a more generous perspective, this may be a tool for price discrimination. Hospitals will charge based on what they think the patient can pay, rather than the actual costs of providing the care. When you receive care, you will be billed for a number that is calculated to make you sigh, flinch, or wince, but not call a bankruptcy lawyer.

This is a symptom of illness in the system, and leaving it untreated seems like a bad idea.

gumby• 6 years ago

I believe medical bills over $100 no longer count against your credit score so of course that created an opportunity to break them out and market them specifically

alexfromapex• 6 years ago

Here we go killing people over money again

mayneack2• 6 years ago

I usually don't give medical providers my social security number. It's on all their forms, but I just skip that section and no one has ever come back to clarify that it's required.

I have no idea if they can require it or not, but I always assumed it was optional because they wouldn't turn away foreigners without SSNs.

oftenwrong• 6 years ago

Additionally, some American citizens do not have a Social Security number.

https://en.wikipedia.org/wiki/Social_Security_number#Non-uni...

Bear in mind this fact when working on systems that make use of SSNs.

ceejayoz11• 6 years ago

Refusing to give your SSN doesn't prevent things from showing up on your credit report.

https://www.experian.com/blogs/ask-experian/accounts-may-be-...

Experian doesn't match information to a person's credit history using only the Social Security number. Experian matches information using all of the identification information provided by the lender, so the account will be accurately shown in your report, even if no Social Security number is provided.

mayneack2• 6 years ago

I guess that makes sense. I have been doing it just because I figure it's an easy way to limit my potential data breach exposure. Didn't know about this medical credit score thing.

nitwit005• 6 years ago

It's common for people to not give SSN, but they don't need it. A name and date of birth is enough to match you to existing records the overwhelming majority of the time. Phone, address, insurance, and so forth, resolves the majority of what remains.

Usually the only time they'll fail to ID you is when you show up to the front desk with no identification and lie about your personal details, which I don't particularly recommend doing.

tantalor• 6 years ago

So wealthy people get access to better care and everyone else has to take whatever is available.

That's how Canada's healthcare system works, too.

Government health insurance plans give you access to basic medical services. You may also need private insurance to pay for things that government plans don’t fully cover.

https://www.canada.ca/en/immigration-refugees-citizenship/se...

altcognito• 6 years ago

This is not how Canada's system "works" by definition as their definition of basic health care is a lot wider than the US.

The above aspect of "wealthy people get to buy nice things" really doesn't contribute anything interesting to the conversation.

Ididntdothis9• 6 years ago

”That's how Canada's healthcare system works, too.”

Their Standard for basic care is much higher though. You can’t compare that.

Spooky235• 6 years ago

Not really. In the US, you get medical coverage if you are old, an honorably discharged veteran, or indigent (either through ER or Medicaid).

In Canada, you get Medicare-like primary care, benefit from price controls on drugs, and can buy secondary coverage to get more. In the US, you get to subsidize drug development for the world and enrich a variety of different cartels.

planetzero• 6 years ago

Universal care is no different. If your surgery is deemed unnecessary, you really have no chance at getting it.

All of my relatives in Canada come over to the US for any major surgery. The reason? The wait time is in years, instead of weeks and some can't get the surgery at all.

"Once you start running a hospital like a business, you create an environment of perverse incentives. Care is no longer solely based on what's best for the patient, but how that patient's care relates to the hospital's finances."

Government-run care is no different. It doesn't magically solve the issue of treating patients as a number.

"So wealthy people get access to better care and everyone else has to take whatever is available"

The alternative is that everyone gets access to sub-par care.

The answer is an actual free market, rather than another, large middleman monopoly over our health care. We need to get rid of all insurance companies, allow hospitals and doctors to compete over price (which will reduce prices for everything to true values (instead of $80 Aspirin), and only have insurance for surgeries that are rare and can't benefit from the free market.

Monopolies are bad for everyone, whether it's big business or the government.

ceejayoz11• 6 years ago

The wait time for an uninsured person for "unnecessary" surgery in the USA is infinite, which needs to be factored into your calculations here.

lotsofpulp6• 6 years ago

A free market requires informed buyers, there is no way 98% of people can be sufficiently informed about medical issues, nor do they have time to research them. The closest option is to hire an agent of equal ability (i.e. a doctor) to verify the claims of your doctor. Obviously, that's too expensive, so the next closest alternative is to use health insurance companies who do employ many doctors to verify proper treatment options (aka prior authorizations).

ebiester• 6 years ago

How does that work for a heart attack? How do you negotiate an emergency open bypass surgery?

developerdylan2• 6 years ago

No. In Canada, they just take you into surgery and treat you. Then you leave without a bill.

Contrast that to the US which could leave a person bankrupt for the same emergency.

developerdylan2• 6 years ago

This is anecdotal evidence. I have friends in Canada who are incredibly proud of their healthcare system. They see the US system as archaic.

Maybe rich Canadians think differently, but universal healthcare will always be better for the general population.

philjohn4• 6 years ago

Same with the NHS that's often derided. Cancer, heart attack, stroke? You'll be treated very quickly with the very best treatments.

Need some physio, but delaying it isn't going to cause ongoing problems? You're going to wait.

If you want to skip the queues then there's affordable private healthcare as well for non-urgent issues ... my plan with BUPA costs my employer £1,600 per year.

bjourne2• 6 years ago

Can you be more specific? Which procedures would they have to wait years for? And how many relatives do you have? All of your relatives doesn't say much if you only have one living relative in Canada.

hourislate3• 6 years ago

I waited 8 months to see a Neurologist in Toronto for a slipped disk in my neck (he was in disbelief and shocked). By the time he saw me, it had healed on it's own. If you are dying the Canadian medical system is great (most of the time). If you suffer from things like back pain, injuries, condition, etc, it will be a long and arduous journey before you get the attention or treatment you need.

I have many more stories, (family member being sent home with an Abdominal aortic aneurysm on the verge of happening (Friday) because the Surgeon didn't have time to perform the surgery until Monday. Guess what happened on Sunday? Guess what else happened a couple of days later?

Wife almost died because she had to wait a month for a specialist. She just couldn't get anyone to take her seriously. Finally got the treatment in an Emergency room (she went septic).

I live in the USA now and have the best medical care in the world for my family.

SolaceQuantum7• 6 years ago

"Universal care is no different. If your surgery is deemed unnecessary, you really have no chance at getting it."

Highly disagreed. I had several unnecessary surgeries as a child in canada. I had some swollen drainage things in my sinuses removed, and the only danger is that I was really sniffly all the time!

"We need to get rid of all insurance companies, allow hospitals and doctors to compete over price (which will reduce prices for everything to true values (instead of $80 Aspirin), and only have insurance for surgeries that are rare and can't benefit from the free market."

Does this mean that the free market means hospitals can choose not to treat patients that are too sick, too black, too gay, etc?

UseStrict• 6 years ago

Yeah that sounds a lot like American propaganda about the Canadian healthcare system. All of my family has had their surgeries done in Canada, and while there is a needs-based component the wait times aren't ridiculous.

Publicly funded healthcare may not solve all issues, but it removes the perverse incentive to refuse or reduce care quality because you don't have access to insurance or cash. Free market means shit to me if I'm mid-heart attack, I don't have the time to review pamphlets about why ABC hospital has the best care for the low-low price of $4999!

rlanday• 6 years ago

And what proportion of the time are you having a heart attack when you see a doctor?

JackRabbitSlim• 6 years ago

Government run care is different in one massive way: It's not a profit seeking entity.

Private insurance, even those run as non-profit, still turn a profit. Does the head of the DHS make 15 Million dollars in year? No? That's the average compensation for private insurance CEOs. Bernard Tyson CEO of non-profit Kaiser Permanente made 16 Million in 2017.[0]

Is that really "all the same"?

[0]https://medium.com/@kaiserkeepthrivealive/this-analysis-look...

philjohn4• 6 years ago

It also spreads the risk pool over an entire nation, rather than who happens to be insured by insurance corp A in state B.

fruzz• 6 years ago

Yes, it's a different problem with universal health care. Here (Canada) the problem isn't oriented around the question of are you rich enough but there's a trade off in wait times. From the Fraser Institute[1]:

There is also a great deal of variation among specialties. Patients wait longest between a GP referral and orthopaedic surgery (39.0 weeks), while those waiting for medical oncology begin treatment in 3.8 weeks.

Still, the Canadian system is demonstrably better when it comes to outcomes. Canadians live longer than Americans, and have lower infant mortality rates for instance. Canadians also pay half of what Americans do for health care, when everything is accounted for. My partner is diabetic; like most medicines its a fraction of the cost of in the US. A universal system brings with it purchasing power. No system is perfect, but this one seems much better than the American one for the average person.

It's a choice. In my case, I'd much rather the Canadian system over the American. Even when it comes to surgery, I had a vaginoplasty (took 8 months between GP consultation and surgery; $25k surgery paid for by govt). My friend got her tubes tied (took a month; paid for by govt). My other friend was in the hospital for a month (admitted immediately; paid for by govt). My uncle had heart surgery. He did not have to lose his house. My step-dad had hip surgery (took 4 months; paid for by govt). Not to mention all the doctor's visits and tests accrued over a lifetime.

[1] https://www.fraserinstitute.org/studies/waiting-your-turn-wa...

emilecantin• 6 years ago

The speed of the health-care system really depends on the specific area of Canada you're in. Health-care is managed by the provinces, and the amount of funding they pour into it can vary wildly. Add to that the fact that medical infrastructures are far from uniform across the provinces, and you get very different results.

I lived for a few years in southern Québec, and I was amazed at the quality of care there. My wife had some pancreatic stones, and it all got dealt with (including 2 surgeries, multiple scans and a 2-week hospital stay) within a couple weeks. No bill. My daughter fell and had a concussion, we were scared about possible brain damage so I took her to the hospital at around 8PM. We were out of there at 6AM after an X-ray, an MRI scan and a few hours of observation. Again, no bill. I had four kids, and I think in total I paid less than $100 for their births, and that was for the food I ate or for parking.

Right now I'm more in central Québec, and the quality of care is a bit lower. It's a pretty rural area, so the budget is probably lower and the points of service are more spread out. Still, I like to know that a medical issue will never bankrupt me.

forgotmypw1• 6 years ago

If a person has no insurance and no money, do you think they should be denied treatment?

nexuist3• 6 years ago

The alternative is that everyone gets access to sub-par care.

Sub-par care is excellent when the current reality is that most people don't get access to any care at all.

You must understand that the vast, vast majority of people don't go to doctors. They don't have dentists. When a poor person is in pain they will continue to be in pain until the pain goes away or they die.

When given that versus a shitty but free healthcare system, who wouldn't want to see a doctor? To get $5 prescriptions to medicine that can help them?

And remember, this is assuming the healthcare system will be shitty - universal healthcare has never been repealed in a country that has implemented it. Don't you think if the citizens of these countries were so fed up with free care, they would be protesting and electing candidates that promise to dismantle it? Even Boris Johnson has to tiptoe around privatizing the NHS because he knows how wildly unpopular that would be, even among his conservative constituents.

homonculus1• 6 years ago

Sub-par care is excellent when the current reality is that most people don't get access to any care at all.
You must understand that the vast, vast majority of people don't go to doctors. They don't have dentists.

Uhh… what? This sounds either out of scope for the US or just wildly inaccurate. Over 90% of Americans have insurance.

Edit: I do not live in a bubble. I stand by this comment, "only" 1/3 delay medical treatment [0]. The claim that the vast, vast majority of people never get it at all is simply false. Fact checks do not bear counterargument in a healthy discussion unless the fact check itself is lie.

[0]https://news.gallup.com/poll/269138/americans-delaying-medic... (2019)

protanopia2• 6 years ago

"Sub-par" in this context meaning significantly higher chance of dying.

https://www.theguardian.com/society/2013/sep/12/hospital-dea...

neplus• 6 years ago

There is also an increasing issue in Canada of minor operations being delayed to the point where major surgical intervention is eventually needed.

With the medical system over-burdened, the system is now fundamentally reactionary in many specialties; delaying anything that can possibly be delayed.

It's saving a penny today to pay a dollar (or a loonie, I should say) tomorrow. It's economically burdensome and, obviously, creates a great deal of unnecessary hardship for those in line.

Nearly every Canadian has anecdotal stories of elderly relatively who had a minor ailment that needed surgery - were delayed for months because they were low priority - and then needed a larger intervention as the problem compounded over said months.

Where does this show up in the data? How do you measure and value up to a year - which can be more than 10% of an elderly persons remaining life - being mired in uncertainty, discomfort, and pain waiting for a procedure? How do you measure medical efficiency and patient outcomes in this context?

The best way to describe the current system is that doctors (surgeons, in particular) are forced not to look out for the individual patient's best interest, but the best interest of their entire surgical waiting list in aggregate (and this can be dozens of names long).

So, yes, it is in the best interest of Patient X to have the minor operation done this week as there is a strong likelihood of further complications and a worse patient outcome if delayed. However, Patient Y needs a major surgery this week so Patient Y, rationally, gets the higher priority.

jiveturkey4• 6 years ago

which will reduce prices for everything to true values

wishful thinking.

we already see this with ambulance service. there is an overabundance of supply, but it has not reduced price. in fact, the opposite as all the companies run much less efficiently (less billable time).

people aren't going to shop and buy on price for hospital care. they are going to shop and buy on local presence. for regular doctor visits, the costs are already low.

zajio1am• 6 years ago

Universal care is no different. If your surgery is deemed unnecessary, you really have no chance at getting it.

There is no reason to have it exclusively. Having single-payer healthcare with mandatory participation for residents does not preclude existence of healtcare providers that are outside of that system.

Although it is likely that such providers would be just a small part, as for patients it would have zero monetary marginal cost to use providers that are part of system, so they would likely use providers outside of the system as a last resort or if there are significant non-monetary cost.

heavyset_go6• 6 years ago

All of my relatives in Canada come over to the US for any major surgery. The reason? The wait time is in years, instead of weeks and some can't get the surgery at all.

I'm in one the largest and wealthiest metro areas of the US, and there is a 6+ month waiting list to see mental health professionals.

"So wealthy people get access to better care and everyone else has to take whatever is available" The alternative is that everyone gets access to sub-par care.

When I lived in Manhattan, despite living right down the street from some of the best paid surgeons in the country, my wealthy clients would fly overseas to France and Israel for their surgeries.

The fact is that countries with universal health care have better health outcomes, better quality of care, shorter wait times for care, pay half of what the US does and manage to cover all of their citizens. Each of those statements of fact can be cited here[1].

[1] https://www.healthsystemtracker.org/chart-collection/quality...

codegeek• 6 years ago

I have thought and thought about this and I have to say that I agree. Right now though, I am ready to shake things up in the US healthcare system and anyone offering a different solution is worth a look. So I am looking at "Medicare for all". I am sick and tired of the current system. So lets try something different even though I would ideally like a free market system where the poor are covered by the Govt and the middle class and rich folks pay out of pocket for MOST things. The moment you remove middlemen like the mafia insurance and overheads like billing companies etc and allow doctors to work directly with patients, watch how prices drop. I guarantee. I mean I pay like $22,000/Year premium for a family of 4. So even if I don't go see a doctor all year, I have paid 22,000. Don't even get me started on deductibles, in/out network , co-pays and all that other crap. Instead, I would prefer going to a doctor and receiving say a $200 bill for a regular visit. np. pay out of pocket. If I don't like that, I go to google and compare prices across other similar practices.

boplicity• 6 years ago

I have a relative who needed emergency surgery in the States. Unfortunately, the billing department would not let her have the surgery, because she was Canadian, and it was Friday, and they didn't have time to deal with it. The surgery had to be rescheduled for the next week, even though the doctor wanted it done immediately. This, despite pleas and offers to pay in cash, in advance – whatever it took.

So, instead the of the rushed surgery, my relative waited. After a day of waiting, she decided to go straight to Vancouver, B.C., where the issue was taken care of immediately, with no wait times.

However, because of the delay, her outcome was significantly worse than it would have been.

Basically, she lost much of her eyesight because of the "billing department."

That's the States for you.

tomp• 6 years ago

I strongly support your line of thinking, but there's a number of issues with this viewpoint that I've identified, and I'm not entirely sure how to solve.

The main one is, the (expected) medical costs are different for different populations. In particular, the expensive sub-populations are (1) the elderly (because aging & death), (2) women (because pregnancy) and (3) some children (born with genetic diseases, birth deficiencies etc. but having no income/wealth to pay for them).

If we argue that medicine should be driven by the free markets, we should also allow the free market to take over other things, but we as a society (currently) refuse to do that (IMO for good reasons).

What's the value of old age? Retirees are almost completely non-productive, a drain on the society... you could argue about saving for retirement (it's "free market") but that's a bit of a lie, you can't "save" labour or energy, so there's always a transfer of value from the working population to the non-working population, and as the non-working retired population increases and the working population shrinks, that's going to become a problem one way or another (both in socialized and in individualistic retirement systems). Old age awaits everyone, a populace would probably be feeling very uncomfortable about their own future if they saw poor old people dying on the streets, refused medical care.

What's the value of bearing children? It's kind of parallel to the above, children are an investment into the future (future workers), currently it's on the individual to pay for this investment (pregnancy, career income loss, more housing, education costs) but the society benefits (extracting taxes / parts of the value produced by this future worker). Should women also bear the cost of medical care? You could say there's always a father in the picture, but some people also claim that fathers should have the option of financial abortion (given that they have no say in physical abortion). Generally I argue that there should be incentives for people to have kids (correlated with their income, so that high-income, usually highly educated people, have more of an incentive to have kids - e.g. some kind of negative tax rate).

And finally, what's the value of a human life? Should we condemn a kid to a short life full of suffering just because s/he was born with some mistake in their body? I mean, resources are limited so we always have to make trade-offs, but refusing medical care to kids born to poor parents seems particularly evil.

I'm not sure what the solution is... personally, I'm leaning towards a "highest highs, highest lows" kind of a society - having some kind of social net (regarding medicine, jobs, ...) while also allowing private markets for those who can afford them (i.e. if you want to buy private surgery, you can, if you're wealthy enough). But this needs to be carefully managed so the whole system kind-of works.

briffle• 6 years ago

The video they show in the page has nothing to do with what the article is about. The person is talking about finding eligibility information for patients for things like worker comp, medicare, etc.

adrr2• 6 years ago

In 2017 financial bureaus changed their scoring system to be more lenient on medical debt and also remove collection reports if paid in full. This stemmed from a state Attorney General settlement against the hospitals that were extorting patients with threats of ruining their credit when disputes between hospitals and insurance companies arouse. Hospitals would just collect from the patients and let the patient deal with the insurance company to recover funds.

Hospitals want this leverage again so they built their own credit system.

JohnFen9• 6 years ago

The medical system in the US is so awful that I already avoid getting medical care unless it's absolutely unavoidable. I guess I need to add "never go to a private hospital" to that habit.

Ididntdothis9• 6 years ago

Same here. Just went to an emergency room with a fever and was charged $700 for 5 minutes with a doctor who told me to go home and stay in bed. I have insurance and had to spend several hours on the phone to get charges reduced to 240.

rhexs• 6 years ago

Why did you go to an emergency room for a fever instead of urgent care or a nurse practitioner working out of a grocery store?

jorblumesea• 6 years ago

As if the US healthcare system couldn't get more dystopian..

tptacek7• 6 years ago

It's not clear from this article how people are being "denied care" based on this Experian product; the video example provided appears to be about a special need-based admission offering at a provider, not a normal admissions process. In other words: a check that you're poor enough to require the special service.

gen2203• 6 years ago

Tacking on to your comment, it's important to realize that hospitals do not usually lose money on patients that can not pay for routine procedures (because of generous government subsidies). The substance of this article certainly smells funny (experian is known to be shady), but it is not as nefarious as the author makes it out to be.

For context, hospitals are only likely to lose money on very complex patient cases, i.e. the kinds of program described in the video. In those situations, it makes sense that hospitals will want to make sure that either (1) the patient will be able to pay or (2) charities or government programs will cover them, once they apply.

Experian's system claims to helps them make that assessment. Will that lead to patients being turned away? Maybe, but it's not a straightforward conclusion, like you imply. The comparison to Uber ratings holds no water.

The reality is that American healthcare is a complicated market with many sources of revenue that aren't patients' bank accounts (charities, govt subsidies, insurance), and it doesn't lend itself well to this kind of oversimplifying analysis.

tptacek7• 6 years ago

To be clear: the impression I got from the video was that this was a charity that the provider was offering, not that they were using Experian to validate eligibility for other charities.

jerry19792• 6 years ago

She mentions that the product helps screen for the patient's "propensity to pay". From that I gather that if the patient has a low propensity to pay, then they get denied by the hospital.

This is from the product's lit:

"Predict propensity to pay using our proprietary Healthcare Financial Risk Score, which factors in historical healthcare payment outcomes and the patient’s credit history"

She mentions that the product also lets them pull "FPL", which in this case I imagine means "Federal Poverty Level", in addition to household size. Cincinnati Childrens has some info that might put that info into context: https://www.cincinnatichildrens.org/patients/resources/finan...

tptacek7• 6 years ago

She says explicitly that she's pulling that information in the context of eligibility for "the charity program".

Further, unstated, perhaps speculative context: most people who go to the hospital pay through insurance and out of pocket. But if you go to the hospital without insurance, or can't cover your out of pocket component, most (every?) hospital will negotiate a lower rate; almost nobody pays rack rate out of pocket. So what they're calling "charity" might just as likely be the name they give the program where they come up with their real rate on the fly (I've been through this process with a large hospital chain in Chicagoland).

Either way: it doesn't support the post's claim that Experian's health score --- which I'm disinclined to trust, just like everyone else --- is being used to "deny care". That's an argument the article does not appear to marshal evidence to support.

cletus• 6 years ago

So I've come to the conclusion that the US model of private health care is ultimately doomed and nothing will save it. Of course it's going to kill people in the meantime but it is doomed.

While on vacation recently I ended up listening to the Bear Brooks podcast [1]. It's a little longwinded at times (but it is aimed at non-technical people) but is not a bad way to spend a long drive.

The interesting thing about this story is how advancements in DNA testing have taken us from the simple case of is or is not a match (used in paternity testing and for forensics) to figuring out how much of a match you are. This has created a new field of genetic genealogy that famously led to the identification of the Golden State Killer [2].

So there's a lot of talk about privacy and your DNA but much like having your contact information uploaded by someone else, this is showing that that will be insufficient as your DNA will ultimately be inferred (at least in probability terms) by people who aren't you. There's really no putting this genie back in the bottle.

So take a disease like Cystic Fibrosis. Currently this requires life long medication and care. Depending on the severity, you may require one (or more) lung transplants. All of this is expensive.

So if you have CF and want to get private insurance in the US this may well be a pre-existing condition and excluded. Now this disease is usually quite apparent from birth but there are other diseases that are not (eg Huntington's). If you'd had a test and know you have it the insurance company has a "right" to know it (if you accept the premise of the US health insurance system, which I, of course, do not).

But this is only going to get worse. Ultimately health insurers will able to figure out if you're much more likely to have certain expensive conditions by knowing, say, that a sibling is a carrier (which greatly increases the chances you have it).

Taken to its natural conclusion, the system of private health insurance cannot survive. The only workable solution is group health insurance. Sufficiently large groups statistically even out. That's how insurance is meant to work. This could be a fully public health system or something in between (eg state-level).

So back to the medical credit score. There will be fights over this. At some point you'll have a right to see it and get corrections. This will probably be championed by states since the Federal government seems to have forfeited, well, governing. But all this is just arranging the deck chairs on the Titanic.

Of course there's still the separate issue of costs (in the US) to deal with but one step at a time.

[1] https://www.bearbrookpodcast.com/

[2] https://en.wikipedia.org/wiki/Golden_State_Killer

sysbin• 6 years ago

I'm starting to think it's better to not be born (into society today) unless born into a rich family. The sociopaths have no checks & balances and everyone can just watch everything get worse.

djsumdog6• 6 years ago

I'm pretty much an anti-natalist. I don't want kids personally. I'm still fine with other people having them, but I can't morally justify bringing people into this world just to suffer.

petilon2• 6 years ago

Great. Now Experian gets to decide whether you can the surgery you need. They also decide whether you can get a job, rent an apartment, and whether you should remain in police custody [1].

[1] https://bigbrotherwatch.org.uk/all-media/police-use-experian...

nixass• 6 years ago

One mention of universal healthcare and all McCarthys of the world unite in uninformed shit talk against it.

Zooper• 6 years ago

To give a real-world example of why this is problematic: my wife recently had surgery, and they had a follow-up a month later to remove a stent. Even though she was insured, a slew of wholly unintelligible bills from various departments at the hospital followed. When she showed up to have her stent removed, the director of the hospital's billing department told her that all past bills must be payed before they are able to remove the stent: this was a blatant lie, and the doctor overrode the decision in about 30min. Now after speaking with the nurses about this, one reveals that the collections department has a whiteboard game going on in the office where they write up their names and have an ongoing competition over who can extract the most money from patients. The hospital and its services are under no obligation to provide accurate pricing until ipso facto, and the pricing can often be changed because it doesn't stand up when placed under scrutiny. Does anyone believe a system like this is capable of producing an accurate "score"?

merpnderp4• 6 years ago

Hopefully Congress passes medical price transparency and this game will end, and price competition can truly begin. If a hospital has to publicly announce they charge Blue Cross Blue Shield 20% of what they charge cash patients, they'll be in an untenable position and have to make drastic corrections.

I expect a lot of service providers to become untenable after price corrections, go bankrupt, get bought out by more efficient providers who remove all the unproductive staff.

Course this is all premised on Congress doing something useful, so...lol.

Ididntdothis9• 6 years ago

“The hospital and its services are under no obligation to provide accurate pricing until ipso facto, and the pricing can often be changed because it doesn't stand up when placed under scrutiny”

That’s what’s driving me crazy. No other business can make up charges repeatedly and when found out, say “oops” and change them a little. In what way is this not fraud?

dfxm122• 6 years ago

In what way is this not fraud?

In the way where you buy the legal definition of fraud from the senate.

cgriswald• 6 years ago

Try being uninsured. I had a woman come into my room (!) during my ER visit and ask for payment. I asked very clearly if this was covering the cost of the visit. I made it clear I understood the doctor and xrays would be billed separately. I paid. It wasn’t cheap.

I got the bill from the doctor. It was reasonable and I paid promptly. I got the bill for the X-ray and it was ridiculously low to my surprise. It was paid immediately. In my mind, I was done.

Then I started getting phone calls from a broken machine. Please call <actual silence> at <more silence> about your past due amount of <~$4000>. I assumed they were spam, but after about 10 of these calls over three days, the message variables were randomly filled or not on any given message. At no point was the message clearly about my hospital visit identified, but I figured it out by the phone number and the name of the parent company.

At this point I hadn’t even been mailed a bill. And I know they have the right address because the other bills came and I’ve only ever lived at my current house since the first time I went to this hospital.

So I went down to the hospital to sort it out. Well, they don’t have a billing department. They have “financial counseling” or something equally not what I need. And even though it was in the hours they are supposed to be there, everyone had gone home for the day.

I still haven’t paid. I haven’t gotten a bill, and I’m not entirely sure the calls aren’t just a scam someone is running.

gotoeleven• 6 years ago

College prices are kind of like this, in that they follow the simple formula

tuition cost = how much you can borrow + how much you can pay

What is strange is why do we stand for huge price discrimination in college and medical care, but not for buying a candy bar?

e40• 6 years ago

My wife was denied short term disability for a foot operation due to a completely unrelated medical issue. It took 6 months to reverse the idiotic decision, which of exactly what they wanted. Infuriating.

cryptonector2• 6 years ago

Hospitals are protected businesses in the U.S. To build one you need a "certificate of need" in most jurisdictions in the United States. I.e., they are government-granted monopolies. They behave like government-protected monopolists do: they rent-seek.

If you want to see affordable hospital care you have to see the protection removed and competition allowed and encouraged.

This is happening to some degree already. Nowadays we have unprotected, standalone ERs, urgent care clinics, and specialist clinics. But it's not really enough, not yet.

Spooky235• 6 years ago

Nowadays we have unprotected, standalone ERs, urgent care clinics, and specialist clinics.

In your example the tail wags the dog. Hospitals are mostly obsolete. You have outpatient surgery in strip malls because hospital beds are capped and reduced, and Medicare began refusing to pay for bad outcomes, which are more common in hospitals.

The government-allowed monopolies are the sprawling health networks the turn medicine into a sales funnel. They are labelled with hospital branding, but the monopolist actions are all about doctors. For example, in my region, 90% of renal doctors work for a single practice.

Urgent care is a whole other animal -- that's all about the reducing standards and addressing supply shortages of primary care doctors caused by restricted supply (there are caps) and higher salaries in specialities.

texasbigdata2• 6 years ago

With first hand knowledge this is correct but much more technically complicated at the ground level than you would ever believe.

Reedx• 6 years ago

I just learned, to my surprise, that pricing and transparency changes may go into effect next year.

Forcing hospitals to disclose prices:

https://www.nytimes.com/2019/11/15/health/list-hospital-pric...

Though the hospital industry is fighting it, so we'll have to see if the rule survives.

ceejayoz11• 6 years ago

I'm completely onboard with price transparency, but am skeptical as to the utility of it to the consumer. I suspect a lot of people will get "oh, we thought it'd be X, but it turned out to be Y, which is 3x the price" sort of scenarios.

I'm sure "colonoscopy, clear" and "colonoscopy, with removal of polyp and pathology on it" will have different prices, but you won't know which it is until after the procedure.

texasbigdata2• 6 years ago

Real world example (slightly annonymized). You have a 50 FTE "billing and collections department". You can outsource, but at a certain scale it makes sense to build your own.

How do you motivate these people? Or manage their performance? Or manage a good outcome for the busieness, the payor and the client?

This wasn't a hospital setting. Much lower acuity. Upon joining they measured exactly this: CPT codes, bills, A/R, etc. 95% of the time those metrics correlate with their job: getting your complex insurance to reimburse for a procedure they administered.

It's a) not clear that's what you should measure, but let's assume it's not the worst thing in the world, b) straightforward how you can get the "evil" white board example you mentioned.

Not saying this is good or bad and American healthcare is arguably broken. But just another example to maybe calibrate your view.

ochoseis• 6 years ago

EconTalk recently did an episode on pricing in healthcare that talks about a lot of these issues. Well worth a listen: http://www.econtalk.org/keith-smith-on-free-market-health-ca...

bobowzki• 6 years ago

I'm so happy I don't live in the US and have to deal with private healthcare.

I hope your wife has made a full recovery!

sjg007• 6 years ago

Next time ask for that demand in writing. That's an easily winnable lawsuit. In fact you should just tell your insurance company that they demanded this AND tell your state's attorney general. That nonsense will be squashed immediately.

TYPE_FASTER2• 6 years ago

the director of the hospital's billing department told her that all past bills must be payed before they are able to remove the stent

That's nuts.

What has changed about healthcare in the last 20yrs to drive up the cost of insurance premiums and pretty much everything?

Ididntdothis9• 6 years ago

A lot of people say you should just not pay crazy charges from hospitals and wait until they reduce or drop them. I bet hospitals want to track people who do that. They want patients who will pay whatever kind of charges hospitals dream without questioning anything.

pdkl953• 6 years ago

Speaking of medical billing insanity...

I recently had a MRI, and in the process of filling out the usual new-patient form at the imaging center, they wanted me to sign a blank LCD touchscreen. No indication whatsoever what I would be signing. Is it even a contract if you never saw the offer and thus no "meeting of the minds"?

After explaining that I wasn't going to sign a "blank check" contract (and would always need to read the entire contract before first), they eventually figured out how print the actual document. After several minutes reading the 8 page (!) contract, I found a clause I haven't seen before. After more or less normal stuff about agreeing to pay for the service, in a section about sending the bill to a collection agency if I didn't pay, they wanted me to agree to 1) pay for the collection agency and any other fees associated with recovering the debt, and 2) pay their attorney fees if they decided to take me to court over the debt.

I wounder a judge would actually enforce that clause. Agreeing to pay someone to sue yourself seems unconscionable. I told them I wouldn't sign their unreasonable contract (that wasn't the only problem) and they sent me off to have the MRI scan anyway.

jiveturkey4• 6 years ago

I wounder a judge would actually enforce that clause.

Yes. It's a normal and enforceable clause. It's very common in all kinds of contracts.

dfxm122• 6 years ago

Depending on the situation, it could be reasonable to argue that you were under duress or undue influence to sign the contract. This is all situation dependent, of course, but it is probably rare that an individual would have the resources and wherewithal to win such a case anyway (which is another problem).

gnopgnip3• 6 years ago

Typically the attorney fee assignment clauses go both ways, and the prevailing party has their fees paid. In some jurisdictions one sided clauses can be thrown out

petilon2• 6 years ago

When you sign the LCD screen without the ability to see what exactly you are agreeing to, that gives you ammunition if needed later in court. When you sign on paper there is less wiggle room for you.

benburleson• 6 years ago

Just sign "No contract provided" and hand it back like it's no problem. If the employees don't care to actually give you a document, what are the chances they are going to scrutinize your "signature?"

sidewndr462• 6 years ago

Recently had an MRI as well. I was given an iPad with lots of documents to sign. Most of it was what you'd expect. Just poorly scrawl your name & initials where indicated.

The one that really jumped out to me was the Power of Attorney. Yes, the provider wanted me to grant them an indefinite Power of Attorney as part of being a patient. I asked if I had to complete this and was told I could skip it. I was really glad to see that about 1/2 the people in the waiting room had the same question.

stronglikedan• 6 years ago

wanted me to grant them an indefinite Power of Attorney

Surely this should be reported to someone that could do something about it. I would hope so anyway, as that seems like a dark pattern that could be litigated.

justwalt• 6 years ago

How does the person in charge of this decision justify that kind of thing to themselves?

pdkl953• 6 years ago

Power of Attorney

If I remember correctly, there might have been something about PoA in my contract. I already hand several reasons to not sign it, so I only skimmed the last ~1/3 of the document.

For comparison, I had a minor surgery (ulnar nerve release) in the surgical center across the hallway from the imaging center. I think they are part of the same umbrella healthcare company? The surgery center only wanted me to sign a short, concise contract that was mainly standard stuff (surgery always has some risk). I don't understand why an MRI (very safe, short) needs 3x-4x longer contract than surgery (always has some risk, involves a lot more people). This seems backwards.

jasonjayr2• 6 years ago

Power of Attorney

Isn't this similar to the same trick those business loan sharks employ? They ask you to sign a "Notice Of Default" or similar document upfront, that they present to the court to get an instant summary judgement if anything goes wrong with repayment?

djsumdog6• 6 years ago

I'm glad I'm not the only one. I just got a signature on a screen for a regular doctor visit and I was like, "What am I signing? There's nothing here."

She gave me a laminated card; three pages. I think she was kinda shocked I read it.

Kinda unrelated ... I was at a Wal-Greens and the checkout person wanted to scan my ID. I was like, "NO! I do not consent."

She called her manager saying, "No one has ever said this before." I asked about their data retention policy, wanted to see their privacy policy. I know this was useless, because they're not going to know. The manager said, "Unless we scan your card, you can't buy alcohol."

So I turned my bag upside down, emptied everything out and said goodbye. I no longer buy alcohol at Wal-greens (or anyone who scans my ID), and I find it disturbing I was the first person who asked.

Most people don't care about their privacy or what they're signing. It's fucking insane.

pdkl953• 6 years ago

"Unless we scan your card, you can't buy alcohol."

PhilosophyTube recently posted a great video essay (Socratic dialogue?) that explores that exact situation.

https://www.youtube.com/watch?v=fCUTX1jurJ4

cft• 6 years ago

I have been traveling in Latin America for the past 2.5 years. In Mexico, life expectancy is 77 years, pretty much the same as in the US. An American retiree expat told me that his MRI cost him $200 here, versus $3500 in the US. I have been to doctors too. A typical payment for a doctor visit is $30 cash, less than my copay in the US. I had a stomach parasite from Guatemala when I flew back to the US. My PCP scheduled tests, then more tests, copays, bills and finally a $200 medication. While doing all this, I simply took a Mexican anti parasitic medication that I bought for $1 (one dollar) in Arrilaga, and it went away, before I got the $200 medication!

I think the medical field here in Mexico is much more affordable because it's cash based, with real competition between doctors

young_blood• 6 years ago

I recently received treatment for Hodgkin's Lymphoma and have been trudging through bills for the past 3 years. I've found that most if not all of my medical bills contained errors, which had I not looked into, would've cost me in excess of $10k+. The most common error was the billing department submitting a bill to my insurance company months after the date I received the services. I wrote a post explaining how I used python OCR to look for these discrepancies.

My father is also a pharmacist (and now owns a pharmacy) and he constantly tells me horror stories about the cat and mouse game that insurers play with patients, where they have doctors prescribe and offer discounts on specific drugs, depending on what is most profitable. He pointed to an interesting bit of software [1] that uses machine learning to find the best margins.

I could seriously go on and on about all the insanity that is our healthcare system. These problems runs deep, from top to bottom.

[1] https://amplicare.com/

jiveturkey4• 6 years ago

It's too bad TFA doesn't mention either way whether a credit freeze will prevent hospitals from obtaining information on you. A bing search reveals nothing.

OT: I left google and use bing now. Interesting, google's search results for my query were absolutely horrible. obvious spam and various detritus. and all the results had the little ad icon ^W^W favicon! I thought they backtracked from that? oh well.

mnm1• 6 years ago

Here's another version, besides the private insurance companies themselves, of the death panels opponents of universal healthcare always blabber on about. Now we have two branches of death panels, each one slightly differently evil. Yet another issue that would be solved by universal healthcare.

rcar• 6 years ago

I've worked extensively with credit bureau data, and there's a fair bit of misinformation both in the article and the comments.

First, bureaus get very little detailed information about the episode of care that led to the medical bill: essentially, they'll just get info on when the bill was due and what amount on it is still overdue, plus enough info on the patient to match it to the right person (name, address, phone, SSN if available). HIPAA and similar legislation allows the sharing of billing data like this, and no other PII (or any PHI) gets shared in the process.

Second, medical debts have been a part of bureau data for a while now. What's new here is that Experian is trying to build a machine learning model on it to try to sell the model as a new product. I've never worked for any of the bureaus before but know many people who do, and in general, these specialized scores seldom sell well, but since the marginal cost to Experian is low (let a few data scientists at it for a few weeks), they still put out new ones anyway. Even things like new FICO/Vantage scores like the new FICO that's been in the news lately tend to take a while (on the order of years) to make it out into the wild since lenders like to have consistency in their processes as long as possible.

Third, it's actually beneficial to most consumers to have medical debts split out of the bureau data explicitly. Most big lenders use raw bureau data much more than the aggregated credit scores, and since the US medical system has so many distortions that correspond more to broken processes rather than a person's creditworthiness, many exclude medical debts from consideration explicitly, and others implicitly as models they build don't often find those attributes as useful as others.

All in all, it's good to be thoughtful about how information like this is disseminated and used, but the dire warnings of the article are really not warranted in this case.

rglover• 6 years ago

https://www.youtube.com/watch?v=EcwyOaYyu7Y

r00fus• 6 years ago

Yet another reason for single-payer.

djsumdog6• 6 years ago

I really hate it when people response to single payer with "I don't trust the Government to..."

First, Medicare/Medicate are contracted out to all the same health care companies that currently do employer insurance. They're given tighter money constraints and can't waste as much.

A singler payer would mean contracting out. Private companies wouldn't go away, they'd become government contractors, would need to reduce waste, stop useless advertising and probably layoff a ton of useless people.

I agree though, we desperately need fully universal healthcare .. where everyone gets the exact same level of care because they're a citizen or tax paying legal permanent-resident.

ycombonator• 6 years ago

Maybe congress should actually focus on privacy legislations than being obsessed with orange man.

alpineidyll3• 6 years ago

Great to see healthcare sector innovating in new levels of depravity. These people put the Marquis de Sade to shame.

doubleunplussed• 6 years ago

Vote for Sanders or Warren, folks.

djsumdog6• 6 years ago

It doesn't matter if they believe in standard health care, they have to be able to implement it, which is going to be very difficult for anyone, no matter if they have a D or an R behind their name.

LatteLazy• 6 years ago

I mean, in a for-profit system you can't blame them. But at the same time, this seems insane to me. Thank god we (still, just) have the NHS...

vkaku• 6 years ago

The medical system in the US needs more regulations, and people should push their politicians to fix this, or vote them out.

nojvek• 6 years ago

You walk into to a supermarket to buy a bottle of milk. None of the items have prices. There isn’t even milk on the shelves. You present your supermarket card to someone and then talk to a consultant who then does a bunch of tests and gets you milk plus some other items (which have high margins - like a special green bottle cap)

Then you go home and receive separate bills that trickle over several months. One from milk consultant, one from the doorman, one from the cleaner and other folks you never even met. The total bill could buy you a truck of milk in other countries but you’re glad you have supermarket insurance and you only pay the price of 10 gallons of milk out of pocket.

rainhacker• 6 years ago

I wonder Experian will buy fitness trackers/apps data now and use it in ratings.

Kelli77653• 6 years ago

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Your New Medical Credit Score Could Deny You Care

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