Cost of healthcare - can I file a complaint?

Discussion in 'Politics, Religion, Social Issues' started by chiefsilverback, Feb 28, 2018.

  1. chiefsilverback macrumors 6502

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    Jul 25, 2011
    #1
    I figured the discussion about healthcare can get a little heated/political so this might be the best place for my post!

    Is there any mechanism to complain/challenge a hospital regarding cost of services? My wife went to our family Dr with a pain on the left side of her chest. Dr ordered an x-ray and some blood tests and she got a call a couple of hours later telling her she needed to get to the ER as quickly as possible because she might have a blood clot and she needs a CT scan.

    Just caught first sight of the bill today and it's north of $5000 all told. To my mind that is damn near predatory pricing, and I'm wondering if there's an legislation/mechanism to go to whoever regulates/licenses hospitals and complain!?!?

    If nothing else it is further proof that the idea that we should treat healthcare like any other good or service, whereby you can shop around for the best deal, is absolutely laughable as soon as your dealing with potentially life threatening conditions!
     
  2. VulchR macrumors 68020

    VulchR

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    #2

    I now live in Scotland but used to live in the US. My first kid was born in the US in a insurance-sponsored hospital, using an insurance-sponsored OB-GYN and an insurance-sponsored paediatrician. In essence, everything should have been covered because those provided the care were preferred providers. Yet we got a $10,000 bill from the hospital that the insurance company laughed at and refused to pay. In the end we refused to pay as well, and the hospital sent debt collectors after us. We threatened to raise the matter with our local government's consumer protection agency and never heard from them again.

    My father was charged in a similarly outrageous way (charged for medical monitoring by a machine that was documented by the hospital's own records as being broken at the time). He used the nuclear option and took the hospital to court, noting that, since the bill was mailed, then the hospital could have been guilty of mail fraud and those responsible could have been liable for criminal penalties. The hospital dropped its claim pretty damned quick.

    My point is that the hospitals and medical companies rely on people being ignorant and failing to get decent legal advice (in my experience, insurance companies do the same). Even if they lose a few cases, they can rely on most people not knowing their rights and coughing up for fraudulent or inflated bills. Don't waste one iota of your time trying to handle this on your own without legal help. My advice is to seek advice from a local consumer support organisation (be that of the local government, such as a consumer protection agency, or a volunteer organisation) or a lawyer.

    FWIW, even with all the troubles the UK NHS is facing (mostly due to a politically driven austerity agenda by a failing right-wing government), it is still infinitely preferable IMO to the insurance hassles in the US system. We pay for our health care through taxes, which distributes the risk according to the ability to pay. I have filled out I think 3 forms in my entire 23 years or so in the UK, and only one of them was about finances (establishing my right as a resident immigrant to get NHS care).
     
  3. chiefsilverback thread starter macrumors 6502

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    #3
    I used to live in the UK, but now live in New Hampshire!

    I'm lucky in some respects, I work for a large corporation that pays an insurance company to minimise its healthcare costs by negotiated the lowest prices possible, so I've yet to see what portion of the $5000 actually needs to be paid, and I have a dedicated health savings account to pay these sorts of bills. From a moral perspective however there are people who aren't as fortunate as me and a bill like this could be life shattering.
     
  4. DeltaMac macrumors G3

    DeltaMac

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    #4
    hmm... Yes, it takes very little medical care to quickly go north of $5,000.
    The only practical time to "shop around for the best deal" is when you are getting insurance - which in some states is limited, or you get no choice at all with your insurance plan.

    Praise ObamaCare (ACA) for this, too...

    What is your deductible that you get to pay on your insurance plan?
    If it is "$5,000", then you may be stuck. You could complain to the insurance carrier, as THEY are really who determines what you pay, as the hospital bills the insurance, and you would only get info copies - unless your procedure is deemed not medically necessary, I suppose.
     
  5. VulchR macrumors 68020

    VulchR

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    #5
    Actually the bill is between the consumer and the hospital - something one learns quickly if the insurance company refuses to pay. You are not paying the insurance company for health care, just for reimbursement of some costs if health care is necessary. Of course, you can take up with an insurance company whether or not they should be paying for something ridiculous that the hospital is charging. Good luck with that.
    --- Post Merged, Feb 28, 2018 ---
    Both my grandfather and father died destitute due to health care bills. It imposes a financial burden on the subsequent generations, so in a way the system is storing up trouble over time, but that seems to be the pattern these days: current generations trying to avoid paying something that future generations will be forced to pay. At some point the younger generations will simply say no and tell the old people to go to hell when they want retirement benefits.
     
  6. chiefsilverback thread starter macrumors 6502

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    #6
    I think the implication was that the insurance company agrees the cost of a given procedure with the provider, so that's what you're liable for.
     
  7. shinji macrumors 65816

    shinji

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    #7
    All any of us can do is try to reform the system.
     
  8. VulchR macrumors 68020

    VulchR

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    #8
    If there is any dispute between the hospital and the insurer, you are liable for the bill (unless things have changed). Again, in the case of my first kid, all medical care staff were 'preferred providers' on a predictable set of procedures that were pre-approved by the insurance company. The hospital tried to pull a fast one, the insurers quite rightly baulked at paying, and we were liable (or at least that is how the hospital and their debt collectors viewed it until we threatened to get local consumer protection on to them).
     
  9. A.Goldberg macrumors 68020

    A.Goldberg

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    Boston
    #9
    First off, I hope your wife is doing well. Blood clots can be very serious.

    There are ways to negotiate medical bills. In fact you can hire advocates to help you with this, but they tend to be pretty expensive and typically you’d use these for people with 10’s to 100’s of thousands in medical bills.

    Unfortunately, $5000 does not seem that absurd for the services rendered. Imaging services provided in hospitals (as opposed to an independent outpatient center) tend to be vastly more expensive. Lab tests are also very expensive*. Going to the ER is also very expensive.

    I’m not sure you’ll have too much success in challenging this. The way this works hospitals and insurance companies negotiate the prices/reimbursement for every service and product used. You agree to the terms of your insurance policy. Where their might be wiggle room not usually with the cost of services, but rather how they are billed. Hospitals have an entire department (called Coding) that reviews medical invoices to ensure they can receive the maximum reimbursement. Sometimes unfortunately they will upcode (meaning use a different billing code than actually provided) or separate what could be grouped services into individual to increase their reimbursement. So it’s best to get a line item invoice of everything charged to your insurance.

    I would think, considering it sounds like fairly routine services, that there’s not a lot of play- but maybe check out the lab tests. They can order individual tests or grouped tests, so it’s possible may have unbundled them. There are certain discounts that sometimes are not utilized (like preferred providers/hospitals) and various charitable programs. At the least you can probably negotiate a payment program or negotiate a lump sum payment.

    Also, when dealing with insurance keep a record of everything and try to get everything in writing and the names of everyone you talk to. Try to be as polite as possible.

    Don’t waste your time trying to call licensing board unless there is blatant fraud being committed. You will otherwise go nowhere. These are contractual agreements between you and your insurer, as well and insurer and the hospital.

    ———
    * Anecdote- My side job is a partner in a residential psychiatric program. We do routine drug testing of our patients for illicit drugs. When you hire a 3rd party lab to send samples, they will charge around $1200 to the customer/insurance. I did a lot of research into this and found if we just paid cash to the lab, we could have the same urine tests done for $16-35 through a reputable laboratory. I looked into a bunch of labs and many of them didn’t even want our business because we weren’t billing through insurance. It’s worth noting many of these sketchy labs provide a $200-300 “collection fee reimbursement” per test... basically a kickback. There’s a ton of fraud in drug testing and you’ll often see people arrested for fraud by overbilling insurers or making fake labs.

    Our policy is that when use instant urine test cups ($4/each). In the uncommon event there is a positive result or we have suspicion, we send it to the lab for confirmation (usually $16). So most of the time our tests cost less than $4. But many places will do 3 drug tests a week and send every sample to the lab at $1200/each. Our system saves money for our patients and It’s ridiculous. Our system saves patients a lot of money and prevents the headache of dealing with insurance.
     
  10. Volusia macrumors 6502

    Volusia

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    #10
    Agree with A.Goldberg re negotiating health care bills. Based on the information you have provided, I would almost guarantee that you have received the bills for medical professionals to read and review the tests conducted thus far. You can request itemized billing and review yourself, but that usually results in small amounts (my wife was charged for tampons and a pregnancy test but had a hysterectomy several years prior.

    I also echo his hope that your wife is doing better.
     
  11. Foggydog macrumors 6502

    Foggydog

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    #11
    In 2014 I was having a terrible pain in my stomach and went to the urgent care with no insurance. I ended up getting a CT scan only to be told that I was passing a kidney stone. That hour cost me 6000. I started making payments but the hospital wanted more per month. So they sent it to collections who won’t get a dime from me.
     
  12. VulchR macrumors 68020

    VulchR

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    #12
    Ouch - I've had multiple kidney stones. Not fun at all, and financial worries would just add to the misery. You have my sympathy.
     
  13. chiefsilverback thread starter macrumors 6502

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    #13
    Thanks for the concern about my wife, turned out to be pleurisy, so painful but not life threatening.
     
  14. s2mikey macrumors 68020

    s2mikey

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    Upstate, NY
    #14
    No doubt that the health care industry as a whole is extremely busted cost-wise. Whos to blame? Take your pick:

    1) Medical professionals - they tend to overbill, over-diagnose, and overdo everything. A hangnail patient gets sent for 12 different tests. Then, procedures cost way too much on top of all of that. Its a bunch of crap.
    2) Insurance companies - For bloating rates, denying claims, etc, etc.
    3) The middle men & HMO's - They just add layers and layers of red tape and cost to the whole thing.
    4) US citizens who mostly refuse to take control of their own health by eating too much crap, being lazy/sedentary, and not maintaining their health. This of course stresses the system due to people like this sucking up a lot of health care dollars which in turn raises rates for everyone.
    5) Companies cheaping out on providing proper health care benefits to their employees. I get that it does cost them something to deploy health care for their workers but when giant companies like Wally Wolrd or even Amazon dont offer good plans or keep everyone part-time, those folks end up in the ER which then bills the taxpayers & the system.
    6) Other stuff I forgot about. :)

    So, each of those would have to be tackled and fixed. Best of luck. Its a mucking fess.
     
  15. chiefsilverback thread starter macrumors 6502

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    #15
    This one isn't a uniquely American problem!
     
  16. BoxerGT2.5 macrumors 68000

    BoxerGT2.5

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    #16

    Is $5000 what you owe or is that what was billed by the hospital to your insurance? What is billed and what is paid are two very different things. Secondly, a trip to the ER is usually between $2000-$3500 and a CT done at the hospital is often right around $1500. Many insurance plans will have a copay for the ER of anywhere between $200-$300. Also understand that 2/3rds of ER docs are independent contractors who may not be in your network (I know it sounds crazy).

    As to your last point, shopping around for elective procedures is a must, but you want to shop around while your wife is having a possible stroke?
    --- Post Merged, Mar 1, 2018 ---

    Number 1 is the result of lawyers. No one wants to be sued for delay of diagnosis should they ever miss something. Because all it takes for one "expert witness" to spout off about the test that if it was ordered would have caught XYZ. Healthcare providers have been taught to do no harm to the patient and to cover their butts extensively in regards to litigation. Blame sue happy Americans for that one.
     
  17. smirking macrumors 68020

    smirking

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    #17
    Chances are the amount the insurance actually pays will be far less than $5000. How much the actual negotiated rate is between the insurer and the hospital is a tightly kept secret. You rarely get to see a real figure.

    Everyone wants to blame the insurance company for the cost of healthcare, but just as much blame should go to the hospitals for inflating costs. In some places, the insurance company has the upper hand and gets to dictate terms. In other places, one or more healthcare delivery networks have become so powerful that they're actually the ones who get to dictate the terms to the insurance companies.
     
  18. Huntn macrumors P6

    Huntn

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    #18
    I’m not saying it’s right, but Emergency room treatment is terribly expensive. Hopefully your bill is mitigated with decent insurance.
     
  19. VulchR macrumors 68020

    VulchR

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    #19
    Thankfully that kind of ambulance chasing hasn't really hit the UK yet. I thought at one point Florida was considering the idea of all punitive damages in a medical case going to a fund managed by the state that is focused on continuing professional education for physicians and also for medical treatment of people who are too poor to afford it. Since the point of punitive damages is literally to punish, rather than making patients and lawyers rich, this makes a lot of sense to me. I am not sure whether the bill passed, for this was decades ago.
     
  20. chiefsilverback thread starter macrumors 6502

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    #20
    Not at all, my point is people will defend the US system by arguing that a free market sets the lowest price etc... because it allows for competition and all that offal. But the reality is, when you're unconscious, or told by your doctor to get to the ER as quickly as possible, you don't have the luxury of shopping around, so you have to pay whatever is being charged!
     
  21. OriginalAppleGuy macrumors 6502a

    OriginalAppleGuy

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    #21
    How care providers determine pricing is interesting. Generally speaking, they price to what the highest bidder will pay. The highest bidder tends to be a specialty insurance company that charges high premiums for "catered" care. It goes down from there. All insurance companies take a gamble. They negotiate with care providers based on what they think their highest claims will be during the contract. If they think they will have 100 hip replacements, but only 20 knee replacements for example, they will offer to pay a lower amount per hip replacement and higher price per knee replacement.

    People without insurance can go to the care provider's finance department and plea for a lower price. Depending on a number of factors, the provider may actually choose to use indigent care to cover the costs. Otherwise, it's pretty easy to get down to a more reasonable cost.

    Understand one thing about medical costs. Government programs have the tendency to not cover the cost of services. Especially Medicaid in general and Medicare for many things. There tends not to be much negotiation on what they pay. So providers have to over charge everyone else to make up the difference.
    --- Post Merged, Mar 2, 2018 ---
    And hospitals HAVE to provide care to everyone regardless of ability to pay. They don't have the luxury/opportunity to run credit checks to see if you can afford services. And if not, withhold care. ER's are loss leaders but they do funnel patients to other services that make up the difference. But not everyone that comes in gets those services.
     
  22. BoxerGT2.5 macrumors 68000

    BoxerGT2.5

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    #22
    No it's very alive and well. The lawyers in government aren't going to put the hammer to lawyers in the private sector.
    --- Post Merged, Mar 2, 2018 ---
    FYI...Reimbursement via private insurance is often based on medicare reimbursement rates. Hosptials/doctors don't pick a number out of thin air for any given service. There's a little thing called "customary" and everyone knows what's "allowable".
     
  23. tshrimp, Mar 2, 2018
    Last edited: Mar 2, 2018

    tshrimp macrumors 6502

    tshrimp

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    #23
    I received a bill for $12,000 for blood work the other day. I thought I would be adding to this with a heart attach from said bill. This was MY PORTION. We called our insurance, and they said it was ours to pay, but they would see what they could do. They ended up paying the entire thing. Here is where it gets bad (dishonest)...

    We called our doctor who ordered the blood work, and the clinic they partner with was supposed to write off that $12,000 due to an agreement with the doctor. From what we gathered after talking to the lab, doctor, and insurance. They send out random bills such as this in hops someone pays it. The lab was supposed to write this off yet ended up getting $12,000 from our insurance company.
     
  24. VulchR macrumors 68020

    VulchR

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    #24

    When my family was dealing with my father's illness this kind of thing used to happen all the time and it was infuriating. It always was a huge sink of time to resolve disputed bills, even when the conclusion was that the bills were not legitimate. This kind of thing made me more of a Leftie, but that's another discussion... Hope you're OK.
     
  25. NoBoMac macrumors 68020

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    #25
    Just to echo what others have already posted, the bill does not seem that unusual what with ER and scans (just walking in the door of an ER can be about $2000 before anything else happens).

    Insurance companies have been coming down on ER visits due to high costs and many people tend to use them vs. urgent care or doctor's office for even the most minor things. A recent story about how Anthem is rolling out across the country (this one is focused on OH, KY) stricter ER policies.

    https://www.cincinnati.com/story/news/politics/2018/02/21/anthem-insurance-er-visits/358165002/

    Here is a great article from 2013 about what a mess the healthcare industry is, big salaries for CEOs at not-for-profits, etc.

    http://content.time.com/time/subscriber/article/0,33009,2136864,00.html
     

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33 February 28, 2018