Restaurants don’t get away with not disclosing their prices on request neither should health care providers.
Medicare for all is a fantasy, and waste of time, otherwise it would have happened under Obama. It would be more reasonable to push for law requiring Medicare rates for all cash payments, and balance billing purposes. This also may be fantasy as the corporations along with their stooges (dem and rep.) will fight this to end.
When I entered medicine, most of the personnel in a hospital provided some sort of care other than a relatively small hospital director staff and the dictation pool. Much of the rising cost of our medical system can be attributed to the massive bloat in people who are medically completely unnecessary. Millions of people are required to provide procedure coding, insurance filing, dispute management, insurance company employees who make their paycheck figuring out how to deny payment for services and medication and “managing” care. At present the vast majority of people carried along in the healthcare industry provide no care, or worse, obstruct care. The soaring cost of healthcare could be dealt with by the government fixing rates and prices resulting in deescalating an ever-expansion that serves no one other than the medical system profiteers.
3
I strongly encourage everyone to read An American Sickness: How Healthcare Became Big Business and How You Can Take It Back, by Elizabeth Rosenthal. I collapsed at home in August, and was rushed to the ER of a local hospital by ambulance. I was diagnosed with diabetes (my blood sugar was 1200) and I had a nasty blood infection. I spent 15 days in the hospital, 5 of them in the ICU. After release, I was put on a six week regimen of IV antibiotics, and a health nurse came once a week to dress my PICC line and draw blood. Note that none of this required surgery. I received a bill from the hospital for over $212,000. I ended up paying only a fraction of that, but that wasn't the only bill. I received other bills for the ambulance, the ER, the drugs used to stabilize me, the health nurse and antibiotics administered, the many diagnostic tests run (xray, MRI, two or three ultrasounds, and a couple of others whose names I'd have to look up.) Now, what I ended up paying out of pocket (because affordable insurance simply isn't available to me, and many like me) would have bought a nice new midsized car, and it represented a considerable chunk of my lifetime savings. When I saw that hospital bill I thought I'd lost it all, including my home. Unexpected medical emergencies and the bills one is faced with are the leading cause of bankruptcy in the United States, and they have been for many years. It really is a racket, and it needs to change. And soon.
6
As an emergency physician and father of college students who have needed out of network care, I am well aware of this problem. That is why I advise family and friends to do the following when they sign in to the hospital. First, insist on signing a paper document and not an electronic pad. On the paper above their signature they should write, “For services rendered I agree to be charged at the Medicare rate and no more.” The consent to Terri’s a contract and if the hospital attempts to bill at a higher rate they will be violating its terms.
5
People do not know to ask how much their healthcare will cost in the presence and absence of various complications. Nor do they know that a hospital bill separately from the treating physicians bill separately from the radiologist who will bill separately from the radiology department. Every time I have gone into a hospital to get an idea of the costs I should incur , I was always directed to the business manager who had no clue either. One cannot have a contract unless they know exactly what they are contracting for and how much something will cost. Until the shroud of secrecy is lifted from The contracts between healthcare providers and insurance carriers it is impossible for the healthcare consumer to get a fair deal. The most I can offer anyone at this point is start with now when you receive a bill and your healthcare provider has already been paid .
5
Another situation where "stand your ground" law should apply.
This is not my experience with emergency surgery following a catastrophic accident that resulted in my paralysis.
First, in an emergency (mine was life and death), any hospital/trauma center is deemed “in network”. I was multiple states from home when my accident occurred.
Second, “in network” providers that receive payments from carriers do so subject to an agreement w the carrier that once it’s paid by the carrier, the provider may not bill the patient for anything.
Third, it is obvious that unscrupulous providers exist. This is why it’s important to keep the Explanation of Benefits that your carrier will send to you each time there is activity on your account. These EOBs helpful to have when an aggressive provider calls to hassle you. I hear them out and say I have the EOB here in my 3 ring binder. You were paid $x by my carrier. Under our state law and your agreement w my carrier you aren’t authorized to make this call. And you violated FFDCA by calling me.
Reject all
5
I have never understood why , after paying the medical bill, I receive a new bill. Never
All I can say is Hallelujah and it’s about time. I rushed my kid to the ER after an MRI of her brain showed a rare tumor the size of a pung ping ball compressing her optic nerves. She was blind in one eye and losing sight in tbe other. The neurosurgeon assured me that the bills would be “approved by our insurance because this was an emergency.”
I received his $273,000 bill every month for two years as Anthem/Blue Cross Blue Shield denied payment. After two appeals they paid less than 10%.
What now??
2
If you are in an ER with a medical emergency wouldn’t signing something like that be considered signing under duress?
12
Does anyone have a bill number on this? I cannot find it anywhere, even if I just search Sen. Bill Cassidy. Perhaps I am searching wrong.
1
here's a thought...become a Canadian where healthcare is included in your taxes. just like in many other developed countries. better hurry up..cuz all the talk from down south might have Canada consider a wall to keep out our neighbours. Frankly, the southern neighhbours haven't been all that nice lately. I've had two babies, an ankle surgery and was diagnosed with MS. I have annual MRIs, see a University of BC Doctor annually. I also take a $1400 a month treatment and someone else pays for most of it. All part of being a Canadian citizen. My kids also get great education at a local public school. All included in my taxes.
8
@Dreena
Fortunately, Canada does not have the Republican lying machine and their willing lackey Fox News to spread lies within your country. Every time I get into a discussion about health care, I am informed that every Canadian hates their system, and that the American hospitals all along the border are plugged with thousands of Canadians seeking American care because they are unable to get life saving care without months of waiting.
I always ask where they heard that and could they direct me to resources that back up their claims. I never get any other response other than that everyone knows that that is true, that they are each personally aware of a Canadian that has been subject to these barbaric practices. The unfortunate Canadian is always the brother / sister of the former neighbor of a person they met at an airport waiting room.
I am, as every American should be, envious of your system.
7
After getting a bill from an anesthesiologist I was told by Cigna “anesthesiologists are almost never in our networks.” Indeed I did a search in a 50 mile radius of my home address and found exactly 2 - both at the same location about 35 miles from my home. Am I to make sure I only go to heathcare facilities where these 2 anesthesiologists practice if I don’t want to be billed out of network? Ludicrous.
4
@BBB
It may be possible to apply for a gap exception with your insurance company. If there are no providers of a certain type within a certain radius of your home (35 miles should qualify), then you may be able to 'apply' to have those services covered as if they were in-network.
The United States is one big cash register with most corporations, hospitals and businesses only caring about the bottom line nothing else matters.
4
Medicare For ALL : 2020. It’s the Right thing to do. No, it’s not perfect. But notice that the only people against it are those that would lose money, like the parasites at Insurance Companies and some Providers that wildly Overcharge. Just saying.
5
When you are asked to sign those crazy long forms that no one reads, use your opposite hand, make up a name or simply write “do not agree “. No one checks them.
2
Insurance companies don't belong in healthcare.
11
It's not just hospitals. I just got a bill from Labcorp for testing services not covered by my insurance. The estimate (which I paid before the blood draw) was $126. They now want another $1532 on top of my payment. I could have ordered the same tests online for $329. I have disputed the invoice and hope they will be accommodating. I would not have consented to service had I know the total cost would be more than 5 times what I could pay independently. Healthcare has become a racket and as much as I fear unintended consequences of government regulation, we must take action.
9
Which is why hedge funds have found this industry to be so profitable.
4
I have known for a long time that the health system in USA is way too expensive. Will it ever change? I have grown more and more skeptical over the 32 years I have lived here.
My experience with this issue started when, after a visit to the local Scripps Urgent Care facility I was diagnosed with a stomach ulcer. So we went to the closest Scripps hospital, and, as many people wrote here, they had me sign agreement forms, and guess what, I didn't think one second about what would happen with the charges. I don't know why, I was only concerned about getting that ulcer taken care of.
So I stayed there one day and one night, and got good care, and I got better. Unfortunately the happy part ended when I received the bill. The shock was due to $ 8,659.00 for an item identified as "ROOM & BOARD". Never mind that my insurance paid 90%, I still was shocked that one night could be so expensive. I tried to get answers by calling their accounting, the employee was evasive, non-committal, obviously trained to say nothing of substance. She implied that the extra cost might be due to the heart and other life signs monitoring. I did not need heart monitoring. I have an excellent heart, all my records show that.
So, from now on, I will try to avoid going to the hospital. And if I must go, I will spend as much time as I can looking at every form and ask the prices for every single procedure. At this point, I feel like I am going to be a difficult patient, but what other choice do I have?
8
@Sansay. I do hope you didn’t and will not pay the $8659.
2
"Hospitals say yes, that signed admission forms, which include a promise to pay, constitute mutual assent, even if there was no price disclosed."
Well what could be clearer than that? It's just like Nixon's "secret plan" to end the Vietnam War.
5
@Charles Coughlin. A contract without a price is not valid!
4
I was scheduled to have an mri. I insisted on getting a price ahead of time. Initially they refused to provide a price, but right before it was time for the exam they sat me down for a consultation over price. We negotiated a price... I have a signed form with a price circled and initialed. Then, months later, they billed me an extra $800. I sent them the contracted, signed, price. They sent it to collections... I refused to pay and it was just $800, but they have harassed me for years.
7
@Jon
You need to sue them under fair debt collection laws using that signed contract as your basis. They, under the law, were not allowed to harass you for the $800. That makes them liable for damages.
8
Medicine as I have come to know it in the past 10 years or so has very little to do with the patient and everything to do with the money and payment. When you are ill the last thing a patient (or their family) should have to do is deal with the stealth way they are charged for services. Insurance companies, hospital facilities, and "medical providers" dictate payments and treatments not always in the patients best interest but always in the interest of their own pocketbooks. Sometimes you are not even told about treatments that might be less invasive or more beneficial because they don't perform it or it's a cheaper alternative. There is a reason medical care is just as good but cheaper in other western countries
Hard to find in medicine, facilities and people that actually care more about the patient then the profit
8
I know how to fix this problem. Do away with the Medicare Regulation that forbids hospitals and physicians from talking to each other about prices.
And require insurance companies to pay - in full - all prices that are revealed in advance of treatment.
3
@mouse854324444. Just disclose in full and get paid 100%! No -
2
The contract theory is compelling. For an enforceable contract for any other service, there must be, among other things, a meeting of the minds as to the promised service and the value exchanged for it. Indeed, in a case where the terms of the agreement are not dickered but are dictated by the provider who holds all the cards, the need for a contractual approach, especially one that acknowledges that these are in many ways contracts of adhesion, is apparent. I wonder if the doctrine of unconscionability should be brought to bear here.
13
Do we EVER hear about balance billing during national elections? Instead, by the so called winning party we hear mob lead chants,"lock her up." There is so much low hanging fruit that would reduce medical care costs yet our political forces don’t care to do their job. Why should they since the consequences are not the same for them. We need leverage to make them attend to our medical burdens. How about taking away their medical benefits until performance limits are reached? Realistically, what can we do? After two years of toughing out blind sided charges and trying to get consumer affairs and my congressman to advocate, it’s a helpless feeling. I’m told that the vast majority pay these outrageous bills. No wonder they keep coming at us. We desperately need negative incentives to change these billing practices. Until then, don’t expect your in network doctor or hospital to have a conscience.
18
I have Medicare Part A, as well as health care through my employer.
I sought an in-network doctor for a medical condition. She never remotely treated it, but did order a bunch of expensive tests unrelated to my condition. After completing 2 of the tests I declined to take any more tests as my medical issue wasn't being addressed. I paid my co-pay at each visit
I went to the emergency room of this same in-network provider for a different condition a few months later. I was admitted, then discharged the next day. At discharge they said my co-pay was $800. I paid.
Reviewing my medical records online, I noted my insurance had paid for the hospital stay and office visits, but the $800 I paid showed as a credit. I called at least 10 times asking for a refund. Each time I was brushed off.
Meanwile, the original doctor started billing me $55. I called, was told I didn't owe, and not to worry, etc. But next I rec'd a call from a collection agency about the $55. I contacted the provider again and asked how could I owe $55 when their own records showed an $800 credit? No answer. Fearing damage to my credit I paid the $55.
After countless calls and six months later, the provider admitted my portion of the hospital admission was $275 and that they owed me $525. But told me not to expect it anytime soon because of the holidays.
I''ll wait until mid-January, then start calling again if I don't receive it. I won't go to them again for anything.
17
@Ann
I think that a visit to small claims court would be in order.
Also, a letter to the Postal Inspection Service. Since they admit that you didn't owe anything, the bill (presumably sent through the mails) was mail fraud.
12
@Ann and put a collection agency on them!!
1
Some years ago - eight, maybe - I elected to have my cancerous prostate removed. My insurance was through my spouse's City of Scottsdale policy. When filling out the pre-surgery paperwork, there was a page from a physician's assistant indicating that he didn't necessarily accept an insurance payment as payment in full. Later, he sent me a bill for $3000, claiming that his application for reimbursement had been denied. I checked with the insurance company. They told me he had not filled out his claim properly, and it had to be billed along with the surgeon. I informed him of this, so he grudgingly reapplied, and was paid $800 for three hours of surgical assistance. He billed me for the balance, and I told him where he could go with his exorbitant charges. I threatened to file a complaint with the medical licensing board. Never heard from him again.
15
I required 4 stitches in my knee because of a accident, went to the closest emergency room. I then got a $20,000 bill. I called the financial office of the hospital and offered a ultimatum, send me a reasonable bill or get nothing. I explained I am have no assets in my name and don't receive a paycheck making suing me a impossible task. They then charged me the Medicare rate which I was happy to pay.
That the doctor had a separate bill was shocking. I did the math on her 5 minutes she spent with me and extrapolated that she makes $15,000,000 a year.
18
@Paulie. And sometimes they just stick doctors on you
1
This is a tough situation for patients. Emergency services typically fall under implied consent treatment as services provided could impact a life or death circumstance. So even if you didn't sign on the dotted line (perhaps you were unconscious) many laws are designed to protect EMS personnel and citizens with a "Good Samaritan" type law which is intended to help do-gooders while protecting them from liability.
Assuming that courts want to address this issue in terms of expenses that fall on the insurer or patient, this process will be fraught with inconsistencies. Most people would be shocked at how much medical services price ranges vary as the article pointed out. It wouldn't be impossible for the courts however determining fair market prices for something like medical treatment historically has not fallen under their jurisdiction so they will lack a lot knowledge on the process of price setting.
What I am worried about is that price transparency might lead to dangerous or unintentional physiological drawbacks. Price should not be the determining factor when electing to have medical treatment. In short, you should go bankrupt before you risk dying. My fear is that a patient will elect to not have a surgery because of the lack of affordability. This kind of decision-making could lead to lethal repercussions. It is my opinion that patients should trust physicians when seeking treatment. I mostly intended for this comment to apply to emergency settings.
@Garrett prices SHOULD be considered when seeking ‘medical’ care. My wife and I go to dufferent dentists in the SAME practice, building, etc. For the same filling type my dentist charges $71, and my wife’s $275. The latter has a younger hygeinist and plays soothing music, I can get a lot of music for $200; and there a plenty of younger people to see.
4
@Garrett No one "should go bankrupt before risking dying." That is ridiculous. People deserve to know the costs of treatments, and decide what they will or won't do. Hospitals and medical personnel don't want transparency because it will put their profits at risk. As well transparency should put them at risk.
1
@Garrett
It’s already happened in Boston. A woman got her leg wedged between the subway car and the platform and had muscle deep gouges as a result. She begged onlookers not to call an ambulance as she couldn’t afford the medical bills.
3
So you need emergency surgery and don't want to pay the surcharge. Can hospital refuse the surgery?
1
@Audaz Yes, if you refuse surgery for whatever reason (cost included) it will not happen. The hospital is not making the decision here unless the patient is unconscious and no spouse or next-of-kin are available through implied consent laws in most states. It is always the patient's choice when they are cognizant.
2
@Garrett
the answer is in this day and age large numbers of patients have no insurance whatsoever and the hospital is not allowed to withhold treatment. so what happens? often the hospital eats the bill. so its not all one sided exploitation of the patient population. People don't get turned away because they cant pay. what they and their insurance companies choose to do after the matter is another story.
But let me throw in another example from my personal situation (I'm a neurologist); I work not for a hospital but in one; I'm a voluntary attending. If asked to see a patient I do so. I don't do any extravagant surgery. I'm only paid because my billing company bills whatever insurance the patient has. I've had patients throw the "surprise" bill at me and I hardly think that's fair. That's not what I believe the bill was designed to .
I bye the way think patient's should have some fiscal responsibility. No one talks about it but a hefty percentage of the visits we see are because patients fail to assume responsibility for their own health. They don't take the drugs they're supposed to. They drink, smoke and don't take care of their diabetes. Why are we as a society responsible for what these people choose to do or not do.
4
@Garrett
Something wrong here. What if it is life or death? What if they want to bill you $1 million?
I have always promptly paid my bills and my debts. If there is a dispute, i work to resolve it. However, I am paying for goods and services where i know the cost or have received a knowledgeable, reliable estimate. THIS INCLUDED MEDICAL CARE OVERSEAS, where the cost was reasonable, and the price quoted up front and totally transparent. This has included routine "well woman" exams and mammography, etc., skin cancer treatments and herni surgery.
We were considered "private pay", so payment due at the time of service. This was no problem as we knew exactly what we were paying for and what it would cost. Our international health insurance also was clear in what it covered - no obfuscating language, etc.
So it can be done. Doubtful that it will be.
For now, to protect myself, if (not ER treatment) I demand to have a written estimate of cost up front. As well as written proof that the provider i "in-network" at the time of service. This approach is most unwelcome. Too bad. It is my very hard earned money and my body. I will take the best possible care of both.
15
The best bill I ever saw was my husband's from a regional hospital in West Texas that had over ten charges of $99,999.99 for the "pharmacy." There was also the case of the ambulance and the plane and every physician employed there sending him bills personally that had already been dealt with by insurance. Later, after he was at a different hospital, he never received any such double billing. It was an amazing difference... especially because the first hospital botched his care and the second one saved his leg.
10
The huge overhead cost of administering our incredibly complex and disjointed system for paying for health care drives up costs for everyone. Single payer now!
27
First time ever in an ER I kept asking everyone what the event is costing me. No one knew. Finally, the attending physician calmly remarked, "The meter is running."
So much for transparency.
The patient's goal is to get treatment. The providers' seems to be make as much money as possible.
Is the US health system broken?
24
@wihiker The US healthcare system has been broken for a long time and will not be fixed any time soon if ever. None of the folks in government, especially in Congress, have a stake in fixing it. Federal representatives are out of touch with how hard it is to pay for care, either in premiums or billing. While being prepped in a ward room with lots of nurses and other patients, the whole room went silent when I loudly asked the anesthesiologist if he was in my network. He called on the spot and he was but I should have been able to find out prior to day of procedure (bronchoscopy).
14
I had a dentist who repeatedly tried to balance bill after every visit. I just wrote "This is illegal balance billing" and mailed it back. The bill went away, and no one mentioned it. Next visit, same thing. I guess they just sent them out to everyone hoping to profit off of people who don't know. I suppose I should have changed dentists, but then I could have ended up with one who followed up on bills they sent.
12
The only rational ‘fix’ for the present unsustainable system, which primarily benefits the insurance industry, andBig Pharma, is a “single payer”-paid for thru a revised and equitable tax policy.
17
Whenever I sign a consent for medical treatment I add to the form that I am only consenting to care by in network providers. This has worked successfully to avoid the balance billing issue.
18
@JC and that's great if you're not in an emergency situation. But if it's an emergency or you're unconscious or both, it might be harder to remember to do that.
9
I once had a specialist refer me to a family practice. When I called to ask what it would cost to do with they were being asked to do, the doctor said talk to the nurse and the nurse said, "What's the matter? You mean you don' t have insurance?" I hung up.
6
“I’m an economist,” said Dr. Lopez, who teaches at the University of Memphis. “I understand how abusive these practices are. There is not a single market price.”
Which is why the GOP lie about how we should all 'shop around' for our health care, as if it were a new pair of shoes, is beyond ludicrous.
We need Medicare for all. Now.
51
@Sandi
We will never have "Medicare for all" or any improvements in any form of governance as long as the GOP has anything resembling power.
Vote every one of them out of office.
4
I agree totally with writing in and changing the wording of the document before you sign it, and then taking a photo with your cell phone.
A question I have is: if it's emergency surgery in an out of network hospital, why didn't Cigna (or one's insurer) cover the full amount? Emergency is emergency. One could die from a ruptured gallbladder and sepsis.
20
I was rushed into our local emergency room with a possible heart problem. The hospital was "in network" but, like others, I subsequently was informed that the emergency room physician was not in network. It turns out that there is a nation wide organisation of emergency room doctors that bills out of network. Talk about organized crime
83
@ian stuart
Same thing happened to me in Illinois. In network hospital, but some of the emergency room doctors were in network (hospital employees), others were out-of-network subcontractors. They worked for IPC Healthcare.
3
I read and re write those contracts to my own benefit. Often places where it says "shall" I write in "shall not" as in "patient shall not be responsible for any charges not covered by insurance" etc. I only had an issue once. Apria the medical device provider couldn't deal with the Medicaid bureaucracy and excessive hold times, so they billed me, then put the account into collections despite my insisting that they read the contract. Eventually all collections and threats ended, I can only assume someone went and read the contract on file.
I've never had a nurse give me a second glance when I take 10 minutes to read and change a contract. The women at the paper processing window often give it a sour look, but at $15 an hour they just don't care to make a stink. A quick scan with my cell phone saves documents for posterity.
I now earn more and am no longer on Medicaid, but the heck if I want to give any more to a bloated out of control health care system.
21
@somsai ....and at Chicago Northwestern Hospital when I went to the ER they refused treatment unless I signed unaltered paperwork.
12
@MS
Yep, that sounds like Northwestern Hospital. They also ask you to sign paperwork without even giving you a copy of it. I made them print out copies of everything I signed. In addition, they initially told me they accept my insurance, then changed that to "we're an out of network provider for your insurance" on the same day I was scheduled to have surgery for cancer. I asked how much the surgery would cost- they quoted me $5000. The actual bill for it was $27,000. The total bill from them for all diagnostics/treatments related to the cancer was $55,000. None of this was covered by my insurance policy. We need to know the exact amount hospitals/physicians charge and the amount covered by insurance up front before we agree to any treatments. I would never have consented to paying $55,000 out of pocket. While Northwestern offers good medical care, they're too aggressive financially. Someone needs to stop this financial abuse of patients.
12
I just told my friend who has health issues about your comment. He says the last time he went to a hospital the contract was laminated and you had to give an electronic signature!
1
THIS is fascinating stuff! More people should read this article than have (I can tell by the comments - Charles Blow's column received 1,700,000 comments to this obe's 15.....) because SO MANY people are personally affected(effected?).
Also brings to mind a friend's dad's bill for surgery. It arrived 2 years after he died from complications of the minor surgery. My friend spoke to an attorney I worked with who said "don't pay it! They waited til the statute of limitations ran out on suing them for wrongful death. Let them sue you, I doubt they will!"
They didn't.
Hospitals - even "non profit" hospitals, are about money, NOT about caring for the sick. It's time that changed, if you ask me.
SB
Expat in Ireland
22
The American medical system is totally broken and should be nationalized. Special interests like AMA run our country and own our democracy. Dems or Reps it's all the same. We need a single payer system so a gallbladder removal doesn't pay for some doctor's boat at the cost of some bodies life savings. We need nationalized insurance like many other democracies throughout the world. Why should a couple pay $20k a year? If this was a real democracy that couldn't happen.
24
@Marco
I completely agree, but trust me: it’s not the doctors getting rich off this messed up system. It’s the insurance companies, and hospital executives.
28
Lisads, I disagree. I had a long time girlfriend that often asked when my income would increase. I overheard her discussing with her mother what a airline pilot vs a doctor 's income was. She was a flight attendant at the time ( there is a derogatory term in the airlines I won't use). I knew my turn with her was limited. She is now married to a doctor that provides her with her toys (horses, and more than a few). Being that he is in general practice and refuses Medicare patients I'm sure his income is being stretched to the limits, but he got a now aged, self absorbed princess. He was her third marriage by 25, she is his first. Almost feel sorry for the guy.
3
@Lisads and big pharma
In our small town our hospital is considered a rural hospital even though we are only 30 miles away from a major urban center. That designation allows the hospital to charge much higher fees for their services then hospitals simply down the road less than an hours drive away. We are out of network for a great many insurance chains, and as a member of a hospital watchdog group we have been seeing medical bills being sent to collections more and more by the hospital. I agree with virtually all the comments as well as the article itself, and the darkside to this whole issue is that for those who can’t afford to fight it end up being sent to collections and for emergency medical condition may never get out from under the economic consequences of their bill. A radical change to our medical billing practices in this country is desperately needed especially for those of us in rural locations. Our group supports a single-payer system of some kind but aren’t wedded to what the final legislation might look like. And by the way our hospital CEO (of a 25 bed hospital) makes vastly more than the governor of our state.
22
In 2001 I was taken to small claims court by a dentist for refusing to pay $22 (really) on this kind of overcharge. The local judge sided with me, though clearly not understanding the issue.
I haven’t been back to that dentist. I assume he’s now added the same layers of intimidating paperwork that I signed at my most recent visit elsewhere, which charged me 40% more than the agreed insurance rate.
8
@Sarah Green Dentists are a big problem insurance-wise. Few if any dentists agree to be compensated by what insurers will pay. They charge what they charge, they'll process the insurance paperwork for the patient, but the patient has to pay whatever the insurer doesn't pay.
10
I have known about "balanced billing," for many years. My wife, who appeals medicare and medicaid rejections, successfully never pays balanced billing. Its a fraud and should have been under consumer protection years ago.
51
@rose6 Several decades ago I represented a client in a personal injury case who had surgery for a broken arm. She was on Medicare, and Medicare paid the surgeon something like $600 when the bill was $3,000, and the doctor's office accepted it. Later, when they found out their was a PI suit, they tried to rescind the payment and demanded payment of the full $3,000. I pointed out that no only does Medicare prohibit balance billing, but state law also did so. They replied that I was right, and they dropped the matter.
10
I'm a lawyer who has negotiated many commercial agreements. If someone discounts off of "list price" too aggressively, it's not really a true list price. That's what's going on here. No one who has any negotiating power at all (like insurance companies or people who negotiate in advance in a non-emergency) pays anything close to the list price.
We should allow for volume discounts up to a reasonable percentage (or looked at another way, they can charge more to out of network or uninsured), but not more than something like 10-30%. If someone is paying $10,000, the list price can't be $80,000, and it's crazy that they try to get that out of the weakest (the uninsured or emergency situations out of network).
60
Do you think the clerk or CNA at the hospital would read the contract if I wrote by my signature that "I accept to pay only reasonable rates that would be charged a medicare patient." I would do it in very small illegible handwriting or perhaps I might carry a stamp or sticker with such verbiage in case I was too weak to write but cognizant enough to know that I was entering a wolf's den. How would that play out in court?
26
@Clarktrask that's the problem, how can one advocate for themselves if they are unconscious or unable to communicate? Or is rushed in for emergency services and thus no paperwork is ever signed upon admittance to the facility? Maybe a tattoo on ones chest saying that by operating on me, you and everyone involved in my care agrees to accept payment at current market rates?
11
I am a retired Emergency Medicine physician. Our professional organization and hospitals maintain that insurance companies should approve Emergency Department visits based on the concept of what a "prudent layperson" would do under similar circumstances. Unchanged back pain that has been present for weeks might not be reasonably regarded as an emergency but acute chest pain, regardless of what the ultimate diagnosis turns out to be should be regarded as a reason to go to an Emergency Department.
Now lets turn to contracts. When the registration secretary asks a patient or their family member to "sign here", "sign here" and "sign here" MOST otherwise reasonable lay people do NOT read and understand all of what they are signing. If they were to insist on an understandable explanation of the details the registration process would grind to a halt.
The entire area of contract law that covers people signing documents that they cannot reasonably be expected to read and fully understand is a farce.
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@stephen A new trend at my healthcare provider is signing a digital pad - no document presented to me. So how does that play in this scenario?
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@stephen
Well what if, after the charade and the patient's coma, the hospital went looking for payment for that $12,000 aspirin tablet, and found that their patient had a mortgaged home and $100,000 of annual income from three separate income streams defined in federal or his state's laws as exempt from attachment or execution in Chapter 7 bankruptcy, and no other reachable assets besides the mortgaged home? Would one think the price demanded would come down a bit?
Also, the last thing I'd think a retired person would need is a "credit rating," so go ahead and have the collection agency call that burner phone.
Surgeons are famous for buying investments that are exempt in bankruptcy, to make themselves poor malpractice lawsuit targets. I'm suggesting that patients do the same. That way we all can find some comfort in the farce...
@ellie k.
I would refuse to sign. What I am signing? If I don't know, why on earth would I sign?
1
Involving more parasitic actors (lawyers) is not the solution: the solution is a single-payer, Medicare-for-all system.
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Single payer and Medicare for all are two different things. And I see you have been burned by an attorney as well as a doctor. Tsk tsk. There are many, many good folk in both professions. Get well soon.
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@James
That theory has failed in Colorado, Calif. and Vermont.
Failure is not a solution, it is a losing outcome. Absurd to keep repeating at failure.
This system is a travesty and should be corrected by legislation. The courts should be ruling against the providers on unconscionable grounds and the prosecutors should be pursing them for extortion.
Sadly, none of this will happen and the little man will continue to get abused.
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When you sign the paperwork agreeing to pay the balance, add "only for in-network providers."
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Some years ago I was in my in-network hospital for surgery with my in-network doctor and was introduced, as I lay on the gurney, capped and gowned, to my anesthesiologist. Weeks later I got a large out-of-network bill for the anesthesiologist. Was I really supposed to question him about his affiliation as I was being rolled into the operating room? Our healthcare/insurance is a mess. Medicare for all!
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@Meg Thrash: The same thing for my neighbor. As a hospital RN, I have heard patients ask their anesthesiologist what insurance they take & none of them know the answer & most hospital anesthesiologists work for the same group. There is no way to ask for someone else.
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@Meg Thrash Yes, I have frequently read about that happening.
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" .. Medicare for all!"
Defeated at ballot in Colorado, only got 21%. Failed in Vermont and California.
So much for memes.
1
The best thing that an insured person can do to prevent the problem Dr. Lopez had is to know what hospitals are in-network and to use them exclusively, to the extent possible. In the case of Dr. Lopez, it may not have been possible to control which Emergency Department he went to. However, when Baptist's Emergency Department called back to say he needed surgery, Dr. Lopez could have called his primary care doctor, reported the diagnosis, and asked for an urgent referral to a qualified, in-network surgeon. It's annoying to have to do that, and it does not solve the problem completely because some of the doctors at the surgery may not be in-network. Nevertheless, it may be the only way to get the biggest benefit of health insurance, which is management of costs.
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@NeilG1217
But even if Dr. Lopez had gone to an in-network hospital, he then might have no control over whether the physicians are in network! My son recently went to an in-network emergency room, but the emergency physician group was not in network and I may be on the hook for about $1,500.
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@NeilG1217
"the biggest benefit of health insurance, which is management of costs"
Unfortunately the costs are managed to provide the greatest benefit to the health insurance companies.
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@NeilG1217 You're kidding, right? You go to the ER with excruciating abdominal pain and get a phone call a few hours later telling you that you need surgery, and now. That's a perfect time to call the in network doctor and ask for an urgent referral to a qualified, in network surgeon who can, maybe, see you in a couple of days, then schedule surgery, then wait for that. By the time that comes around you might not need the surgery anymore, but at least you stayed in network.
3
The fear of balance billing keeps me with an HMO with a maximum out of pocket of $3000.
Another issue related to billing is not getting the bill in a timely manner, I have seen bills one year after service. 90 days should be the maximum.
Lastly some bills are incomprehensible even by a physician. When most items are listed as "other services" you have to ask for each item "what was this", etc.
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@Sutter
There are separate out-of-pocket maximums for in network, and for out of network.
Many times the out of network maximum is that there is none - it can be infinity.
1
@Sutter. Are you related to the Sutter Health Crook’s?
Sadly, it's an old song that never seems to stop playing. The best I ever heard was from a friend who went into the hospital for minor foot surgery, and received a bill from a gynecologist who stuck his head in the door of her room and said hellow. She fought the bill and won, but was disgusted by the whole series of events. The 2 words that truly anger me are "reasonable and customary". I would really love to find a doctor or hospital that will settle their bill for it!
31
@George Some years ago I was referred to a surgeon for an operation. Before I was wheeled in to the operating room I was asked by the surgeon if I minded if my primary care doctor observed the operation since he liked to watch the procedures performed on his patients. I assented. Four weeks later I got a whopper of a bill for his “assistance” during the operation.
I refused to pay it and let him and the surgeon know why in writing. I never heard from him again.
1
This isn’t billing, it is a shakedown.
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Amazing that nowhere else in the developed world does anyone deal with this healthcare billing nonsense. This is what happens when we have hundreds of bill-paying middlemen (insurance companies) between us and the doctors
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@EmmettC
Those "else's" are failing patients --
https://www.nytimes.com/2018/01/03/world/europe/uk-national-health-service.html
IMHO, copying failures is simply ridiculous.
We need a federal law that requires healthcare institutions to both give a reasonable estimate of charges before rendering service, and to seek all balance payments directly from insurance companies if the patient's insurer fails to pay.
The practice of requiring patients to accept financial responsibility in the absence of an estimate violates the 5th and 14th Amendments.
24
@Sequel - In what world do the 5th and 14th amendments apply to hospitals?
2
@Sequel Easier: We need a federal law that provides for single payer.
4
My doctor wanted payment in full when services were delivered. I paid. I was rebilled for the same service at an inflated fantasy rate because an out of control billing department felt the doctor should have charged more. I complained to the doctor. She sided with me which resolved nothing. The fantasy bill was going to collection. I complained to the State Attorney General. The billing department suddenly announced that the bills were paid in full when the AG looked into it.
On a side note this billing department (part of an internationally famous medical group) had extensive one star reviews on yelp for exactly rebilling each service at a higher fantasy rate AND yelp took them and their reviews off line allowing them to continue their fraud. It was when I read those reviews that I realized legal action would be required to stop them.
The billing departments and yelp need to be prosecuted under RICO.
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@SW Right. There is a billing group across from St John's who on one occasion billed me and workman's comp, collected from workman's comp, then sent a collection agency after me for the same fee. On another occasion the same group simply added a zero to one of the fees. Impressive. I wonder if we are writing about the same group.
19