I want to reply to Zack Cooper of Yale as I strongly disagree with him on one topic. A screw the patient out of network billing strategy is a viable strategy for hospitals:
Low waits are great. That wasn’t the point. The point was that this hospital was focused on emergency care. Hence it knew it would see out-of-network patients. It should have had a strategy. ‘Screw patients’ is not an effective strategy.
— Zack Cooper (@zackcooperYale) August 31, 2018
My area of disagreement is simple. Insurers long for the day that they are more popular than chlamydia as that was at least fun to acquire.
Hospitals and, far more importantly, doctors are trusted and liked. Emergency rooms that treat people for heart attacks have a halo of good will even if there is a $100,000+ bill as the patient is still alive and kicking.
So when there is a billing dispute that ends up producing a massive surprise bill, the less popular and barely liked entity, the insurer is usually blamed for not doing a good job of taking care of the bill.
Screw the patient is a viable business strategy for a hospital as long as it can do so in a way that does not garner national press attention.
OzarkHillbilly
Screwing the patient is the business strategy of damn near everybody in the Medical industry. No matter where you go or what procedure you have performed, you are opening up a Pandora’s box of medical opportunists all trying to get their piece of the ever shrinking pie that is your bank account and you have no idea who or how much they are going to try to stick you for until the bill arrives in the mail.
I am now at the point where I refuse to pay any of these vultures before it goes to collections.
Dorothy A. Winsor
As someone who had a heart attack on August 3 and has not yet seen the bills, this makes me nervous.
satby
@OzarkHillbilly: yeah, I thought “screw the patient” was the medical industry business model.
None of them have the patients’ best interests at heart, though they try mightily to convince you they do.
Baud
Patient should have shopped for a cheaper emergency room.
daveNYC
This is probably the biggest draw for a Single Payer system. Whatever else is involved, at least you won’t have to worry about some huge-ass bill coming your way.
OzarkHillbilly
@satby: “Don’t worry about the money.” The 5 most disingenuous words in the English language. The hospital and I made a deal for the MRI on my shoulder: $850 and some change. I paid $200 and set up a 6 month payment plan for the balance. This latest bill showed I owed them $1024. I need to write them a letter and tell them where they can stuff the extra billable dollars. Especially considering they never told me I would be getting bills from people I never signed any kind of contract with.
different-church-lady
@Dorothy A. Winsor: And nervous is exactly what we want someone with a heart condition to be!
Bob Hertz
It appears that 99% of the abusive cases occur with patients who are under age 65. The protections offered by Medicare are invaluable.
debbie
I’m finding out what insurers like to do with people they think are enrolled in Medicare, like separating you from your access to your money in your HSA — with zero notice.
debbie
@OzarkHillbilly:
I remember that kind of crap from when I was uninsured for 15 years. What a dance you have to do to keep up, all with a (I know you’ll disagree) patient and polite smile on your face.
Schlemazel
@Dorothy A. Winsor:
Had mine literally 1 year ago, may part was very small for everything except the ambulance ride which cost me about $500.
Percysowner
Years ago, my nephew was in the hospital. When his parents got the bill they saw several bills for doctors they never saw and that their son didn’t talk to. Basically, it looked like, any doctor who was on the floor wandered in, looked at his chart and then billed for an hour of his time. It’s not just the insurers that are pushing up the bills. Most people in the chain who can benefit from billing has their hand in it. I don’t say everyone because 25 years ago I called my doctor when my daughter had an ear infection. It was Sunday and I expected to be told to go to Urgent Care. Instead he said he was doing hospital rounds and if I could meet him at the hospital he’d look at her. I’m not even sure he billed me for it. He was a GREAT doctor. I loved him to pieces and was sad when he finally decided to retire.
Schlemazel
There was a new scam set up in the suburbs a while ago. One of the clinics started advertising “Urgency Rooms” and people foolishly assumed it was a marketing gimmick for urgent care. Then the bills came & they discovered these places charged like a hospital ER and the patients were left with huge bills. They defended themselves by claiming they never said they were urgent care clinics and they were much more like an ER even though they were not part of a hospital.
Yeah, screw the patient,
OzarkHillbilly
@debbie: Sad to say, this is WITH insurance. I think my wife got their exclusive “No Claim Policy” thru her work.
debbie
@OzarkHillbilly:
Bastards.
Just One More
@Schlemazel: Here in Ontario, the cost for an ambulance is $45 (unless the doctor deems it unnecessary, then its $245 – the average across Canada looks to be about $125 to $150, depending on province
Just One More Canuck
@Schlemazel: Here in Ontario, the cost for an ambulance is $45 (unless the doctor deems it unnecessary, then its $245 – the average across Canada looks to be about $125 to $150, depending on province
Sorry for the double post – FYWP auto fills most of my nym – forgot to fill in the rest
HeleninEire
I just came back from a presentation regarding private health insurance. It is used here to supplement the single payer here (which isn’t great. The health care itself is good, but there are ridiculous waits to get care that is not an emergency).
The top of the line plan will cost me about €1,800 PER YEAR. There are deductibles, but they are minimal. And I am turing 56 in a week. It’s €1,300 if you are under 35.
Top of the line dental €375. Full coverage for routine services twice a year, and then 70% coverage for the big stuff.
Ireland is generally behind most European socialist countries in terms of health care. Especially the ones that are truly single payer. Everyone complains all the time here, but we are so far ahead of the US. In January I spent 7 hours in the emergency room (nothing serious, I just fainted, but it was on a public sidewalk, so an ambulance was called). I was billed €380. That would have been $10,000 in the US. Also, too? every 4 hours they come around with free sandwiches and tea!
MomSense
@Percysowner:
I had a pediatrician who lived down the street and he used to come to the house when my son had bad asthma attacks. I baked cookies and we watched movies. When his wife had twins, we did a lot of babysitting stints. He was the best doctor.
HeleninEire
@HeleninEire: ETA here: since I can’t edit the comment: That €380 I was billed was without any private insurance.
Ken
@Baud:
Next time he’s having a massive heart attack, he’ll know not to go to that ER.
JGabriel
Only Slightly OT: In Cole’s Twitter sidebar, he’s currently retweeting a satirical ad Randy Bryce made about/for his opponent, stretched-out-Jason-Biggs-doppleganger Bryan Steil (aka Plan B-Ryan).
Anyhow, I just wanted to point out this reply from the twitter thread that follows:
JGabriel
Whoops. Posted in the wrong thread. Really, really missing that editing button.
VOR
A variation is to have outside groups doing billing for the hospital. I had a sonogram performed at my local hospital. The bill came from a 3rd party radiologist and I didn’t recognize the name because nobody ever said their name. The hospital had correctly billed everything to my insurance, who is a major national carrier. The 3rd party somehow billed it to a completely different insurance company where it naturally wasn’t covered because I wasn’t insured by them. So the bill was pretty high – uninsured rates. I panicked at first but them figured it out and contacted them with the correct insurance rates. The insurance company covered the procedure and paid them about 20% of what they billed me. Later in the same calendar year I again had a procedure performed at the same hospital. When the bill from the radiologist (once again, nobody ever mentioned their name at the hospital) arrived and they had again gotten my insurance wrong. Once again, when my insurance covered it the rate paid was about 20% of what they billed me. My conclusion is this 3rd party bills incorrectly as a standard procedure in hopes of getting someone to pay an inflated bill.
Eric S.
I vote this goes on the rotating banner.
“Insurers long for the day that they are more popular than chlamydia as that was at least fun to acquire.”
Eric S.
@Baud: I recognize the snark here. I agree but I want to relate story. I work for a utility in Chicago. One of our Revenue Protection Unit guys was out doing a lock off for a steal. He had finished the work and was sitting in the truck doing paperwork. He got rear ended. Hard! When the police and ambulance showed he refused to go to the hospital. He made that choice not because of cost but because of quality. The closest hospital has a bad reputation. He limped his totaled truck back to the shop then went to a better hospital for care.
StringOnAStick
Those urgent care + emergency care places are turning out to be quite the moneymaker/taker. We went to one when some raw fish the night before left me with a headache that I thought was a stroke or my head exploding. In order to give me the drugs they wanted to cure the nausea and headache, it had to be by IV, which upped it to an ER visit. The bill to our insurance company was $6,500, for 2 drugs, an IV bag and an hour in a room. When this urgent + emergency place was being built near our home, the information provided to the city was that the ER part was just for stabilizing people before they were transferred to a hospital; that seemed odd to me since only 3 miles away is the new level 1 trauma center so why waste the time to get a person out of the ambulance, into the “mini ER”, stabilized, then back in for the trip to the big trauma center? Turns out stabilization is a ruse, it was just to attach an ER to an urgent care for the sweet, sweet dollars available when they can up code.
Proudgradofcatladyacademy
Having worked both as a medic, ER tech in a county hospital, and as a labor doula, I don’t trust any hospital, or doctor. I witnessed manipulations, denial of needed care and one doctor who in my considered opinion committed birth assault on a client. I am extremely skeptical of any doctor., or clinic/hospital can make the best evidence based recommendation for my health. I like most nurses though as they seem to be the only ones in the system who will advocate for their patients’ best interests..
I also understand that doctors, and medical staff need to be paid for services rendered. However, working on the physician contracts side for an insurance company, just solidified my belief that doctors are the greatest actors in the world and will throw patients under the bus to satisfy their greed and pathetic yet giant sized egos.
Recently I fell and had to be transported to the ER. It was just a hamstring injury bout my blood pressure was 195/140 even after the administration of Fentynal. That should have been an admission right there. In fact my primary care physician was stunned that they didn’t admit me with a blood pressure that high. Money probably had something to do with that decision to not hospitalized me.
Our current system is akin to the Medieval Catholic Church, we worship at the altar of medical science in clinics and hospitals and doctors act as the priests. The people don’t question the science or the medical priests enough, and willingly hand over their money in hopes of achieving immortality. The system is corrupt and needs a Luther nailing some sort of medical Disputation of Power of Plenary Indulgences to the hospital door.
Bob Hertz
The idea that each hospital sends out the largest bill it can imagine, and then the patient has to lawyer up to negotiate, is about as grotesque a distortion of the Hippocratic Oath as can be imagined.
It all comes back to hospitals needing to survive on user fees, rather than taxes or charity.
For now, we need health courts, where patients can challenge outrageous bills as unfair trade practices.
Chris Johnson
@Eric S.: No. They do not long for that. They long for all of your money and don’t give a shit what they have to do to get it, and they don’t give a shit what you think of them. They are entirely predatory and should be abolished.
David should leave. We don’t need this point of view underscored. Leave here or leave this line of work and go do something that’s not evil.
Another Scott
@Chris Johnson: Um, are you new around here? Mayhew/Anderson did a lot to help rally people to pressure Congress to keep the PPACA as the law of the land.
What have you done?
Cheers,
Scott.
Chris Johnson
@Another Scott: Nah, I’ve posted for more than ten years. I don’t like David’s attitude or posts. He is a soulless technocrat and the stuff he’s saying doesn’t worry him. He’ll say “Screw the patient is a viable business strategy” unquote and he means it, and thinks in some way that is an appropriate way to behave, perhaps because as a business strategy it defeats or kills other rival business strategies.
None of that is okay in healthcare. It needs to stop.