[HN Gopher] Surgery estimated cost $1,300. Then the Bill Came: $... ___________________________________________________________________ Surgery estimated cost $1,300. Then the Bill Came: $229,000 Author : 8bitsrule Score : 205 points Date : 2022-05-21 20:04 UTC (2 hours ago) (HTM) web link (www.nytimes.com) (TXT) w3m dump (www.nytimes.com) | lifeisstillgood wrote: | Ok this is a silly question but would a simple law that's says | "you must provide an estimate before any medical procedure and | cannot charge over that". And these charges must be available on | your website and fixed for 60 days. | | then you might see some competition ? | | I mean my NHS - born heart hurts at the idea but still ... | temp8964 wrote: | If you read the article, the hospital made a mistake, didn't know | she's an out-of-network patient, so got the insurance wrong. | | If you only read the title, it sounds like the hospital scammed | her. All the reports on this news sound this way. | | The downvotes are crazy. I in no way indicated that the woman | should pay the full amount because of the hospital's mistake. | | Also, if you have an open mind, you could see another | perspective: her insurance is amazingly good, cutting $23k bill | to $1.3k. | LeoNatan25 wrote: | The hospital making a mistake and then over-billing her is | scamming her. Made a mistake? Take responsibility. | temp8964 wrote: | What's your point against my comment? You think I am the | lawyer of the hospital or something? | DangitBobby wrote: | I should not be held liable for your fuckup. You tell me a | price, were wrong, and sold me something that inherently | cannot be returned, you fucked up. Not me. Your money is | gone. Maybe you should be insured against your own fuckups. | | I understand that it being an estimate muddies the waters a | bit, but if a contractor estimated $2k to do my windows and | it cost him $200k (somehow??!) any contract that holds me | liable is clearly unconscionable. I would hold that | contractor in the same contempt as I do this hospital. | LeoNatan25 wrote: | Your comment makes it seem as if the title has been | editorialized unfairly, when, in fact, it is very apt and | to the point. Also, your attitude. | mlyle wrote: | > If you only read the title, it sounds like the hospital | scammed her. All the reports on this news sound this way. | | Well, personally: if I'm told that something will cost me | $1300, and then there's a mistake, and they'll actually consult | a big pile of papers _that I 'm not allowed to see_ to decide | what to charge me... that sounds like a scam. | | With an accurate estimate and correct information about the | hospital not being in network, she would have chosen a | different provider for her surgery. | | > Also, if you have an open mind, you could see another | perspective: her insurance is amazingly good, cutting $23k bill | to $1.3k. | | ? Hospital estimated $1300 after her insurance, and provided no | other info. Then she was billed $229,000. No one cut her bill | to $1.3k, other than the legal system requiring the hospital to | honor its original estimate after litigation. | spywaregorilla wrote: | One should not need to pay $230k for back surgery regardless of | circumstances. | temp8964 wrote: | What's your point against my comment? | adra wrote: | Let's say I bought a server from Dell. They quote me a cost of | $6000. Maybe they assumed I was part of an MVP program that I | hadn't been aware of. I have it delivered and installed and | later the rep invoices me the price at 1 million dollars for | the server because they made a "mistake" on the discount. I may | have signed a resale agreement telling them that I'd pay for | the hardware sent to me, so tell me how this is fair and | equitable trade practices? It may be viable to ship the server | back and call the sale a wash, but there's no rolling back | medical treatment. | temp8964 wrote: | What's your point against my comment? | Closi wrote: | I'm not OP, their point is that in any other consumer- | facing industry you can't just give someone an estimate, | provide zero other guidance on pricing, get them to sign a | contract that says they have to pay you whatever you want | (and if they don't sign, they don't get potentially | lifesaving care), and then after delivery of the | good/service you then charge an entirely different amount | which is 200x higher because 'oops yeah our bad we got the | estimate wrong by a factor of 200 but you have to pay that | now, tough luck'. | | In reality, consumers in the USA seem to have more | protection buying a can of beans than they do in paying for | cancer care - but this doesn't have to be the case! | temp8964 wrote: | Did you read my comment? Where did I support the | hospital? | cmeacham98 wrote: | I can't tell if you're trolling or being serious? | | > If you read the article, the hospital made a mistake, | didn't know she's an out-of-network patient, so got the | insurance wrong. | | Surely you understand putting this with nothing else next | to it is making excuses for the hospital and implying the | patient is in the wrong? | s0rce wrote: | The fact that the "chargemaster" (never heard of this) is a | proprietary trade secret is absurd. | Threeve303 wrote: | Imagine going grocery shopping because you need food to live. You | see the prices posted and you pay at the register. Then a few | months later Trader Joes sends you a bill for $200,000... The | entire Health care system is absolutely insane. | ketanmaheshwari wrote: | These kind of overly simplified comparisons are tired and | doesn't help anyone. Healthcare billing is insane yes but is | not same as buying groceries. | HFguy wrote: | But here's the thing...it could be made to be that simple. | geoduck14 wrote: | Let me give you a comparison from my personal experience. | | My wife was pregnant. The hospital she chose to give birth in | specialized in giving birth. Our health plan was administered | by a large company, and was used by over 10k employees at our | company. | | During the pregnancy, I tried multiple times to determine how | much the pregnancy would cost. Neither the hospital nor the | insurance could tell me _any_ estimate for the cost. I had | _no_ way to price shop or save or budget. I was _completely_ | at the whims of the hospital and insurance. | | Also. They over charged me for _at least_ one procedure. | peter422 wrote: | My wife gave birth at a hospital in our network, but our | daughter needed ICU care (in their opinion). We were given | no choice in the matter and our child was taken to the ICU. | And surprise, surprise, the ICU doctor we had no choice in | selecting was not in network, and a low 5-figure bill was | racked up for care we didn't really want and our child | almost certainly didn't need. Also a very difficult thing | to fight when you've got a newborn. | Chris2048 wrote: | > We were given no choice in the matter | | How on earth can they charge you then?! | spaetzleesser wrote: | "Also a very difficult thing to fight when you've got a | newborn" | | Same for people with a serious disease like cancer. They | don't have the energy to spend all their time on | negotiating with hospitals ind insurance. They either pay | up or go bankrupt. | Freak_NL wrote: | Man, that kind of experience would really make me lose | faith in society. My wife needed a caesarian and was | rushed to the operating theatre, but at no point was | there any thought about cost -- I just trusted that the | doctors knew their business (and they did). It's so | completely natural that anything that can happen while | giving birth is covered by our mandatory healthcare | insurance that the thought wouldn't cross your mind in | the Netherlands (and obviously no bill came). | | Hospitals and pharmaceutical companies do funny stuff | with pricing worldwide, but at least patients aren't | usually bothered with it. | peter422 wrote: | Well nobody really has faith in the system to begin with. | | We went into the process battling the system and ended it | battling the system. | | The various types of care that were provided were all | fine and good but the decisions about which care to do, | who does it and how much it is going to cost leaves a lot | to be desired. But you know that going in. | freedom2099 wrote: | I live in France... my wife is pregnant and the birth will | cost us nothing! Regardless what might happen. | onion2k wrote: | How is it different? | folkhack wrote: | If we're to exist in a capitalistic society where healthcare | has a price tag, then I have a right to see that price and | have confidence that it won't change arbitrarily. | | Due to the abstract nature and infrequent experience of | healthcare solutions in the US, I believe people need to have | these abstractions drawn to illustrate the absurdity of it | all. | SkeuomorphicBee wrote: | It is in my country, so why couldn't it be in the USA? Here | we always know how much I'm going to pay for a procedure | ahead of time, no surprises, procedures have sticker price | just like groceries. | | - If you have health insurance: you always know ahead of time | what hospitals are in network, then the price for all out of | pocket expenses are listed in the contract with the insurance | company (prices adjusted yearly). You only ever deal with | your insurer, out of pocket co-pays came in next months bill, | just like a phone bill or credit card bill , it is actually | illegal for a doctor or hospital to charge you directly for | anything in that case. Any dispute (like the one in the | article) is a business matter between the insurer and the | hospital, nothing to do with you. | | - If you don't have insurance and decide to go for a private | hospital: the hospital will sell you a fixed price package | for each procedure or a big package for the whole stay, each | with a fixed contract signed ahead of time. There is no | surprises, no one signs a "blank check" to the hospital like | those "service agreements" in the USA. | LeoNatan25 wrote: | In proper, modern countries, healthcare "billing" is simpler | than paying for groceries. | [deleted] | ModernMech wrote: | It is only insane if you think the purpose of the healthcare | system is to provide healthcare. A lot of people make that | mistake. The whole thing makes more sense when you realize the | purpose of the healthcare system is to generate profits. | paulgb wrote: | No, because the entire purpose of grocery stores is also to | make profits, and yet they price competitively and | transparently. The problem is that healthcare has senselessly | been given a long leash to price opaquely in a way that | doesn't allow price discovery to emerge. | spaetzleesser wrote: | The health care system has somehow figured how to get away | with extremely predatory practices. | ModernMech wrote: | > The problem is that healthcare has senselessly been given | a long leash to price opaquely in a way that doesn't allow | price discovery to emerge. | | Right. Put differently, the healthcare system has been | smartly given a long leash to price opaquely in a way that | maximizes profits. | midasuni wrote: | There are 200+ healthcare systems in the world. | | Are there any nearly as insane as America's? | peyton wrote: | Vietnam's is pretty nuts if you want to do some deep reading. | Hnrobert42 wrote: | My experience with it has been decent, but I am an expat | with Western money. | | For some stuff like a rabies shot or my girlfriend's oral | surgery, we used the public system. It was cheap and and | reasonably efficient. | | For everything else, we used a private hospital. It was | also cheap, and the quality was comparable to the US. E.g., | under $500 total for an endoscopy, a sonogram, doctor's | visits, etc. to diagnose and treat a stomach ulcer. | | All of that was in the last 3 years in Ho Chi Minh City. | | Now, there certainly are some squalid hospitals, especially | in the countryside. Further, $500 is a lot of money for | most VN people. Having written all this, I guess I realize | all I have are some anecdotes. | contingencies wrote: | I had to find a hospital in Haiphong once. Memories of | limping in to an emergency ward at dawn begging for | painkillers only to find the beds and floors covered in the | blood of the last night's patients... | rdxm wrote: | mobilio wrote: | Archive: https://archive.ph/9ezo4 | punnerud wrote: | I studied in US and one of my classmates from Norway was mildly | hit by a car when she was biking. Just to be sure she did not | break the leg she took an x-ray. The bill accidentally was send | to her address with a request for $8000 (luckily covered by | insurance). | | We almost don't pay anything in Norway in comparison, I think the | maximum yearly amount is $150 if you have to go a lot to the | hospital. | | I have operated my arms several times after different action | sports accidents as a child, with no cost (under 18years you | don't even pay the $150). | | Such a peace of mind to know we have good health service if we | need it. Possible reasons why we kick ass in winter sports? | | Healthcare could be better compared to some of the most advanced | cancer treatments in US, but not sure if most Americans can get | them? | spaetzleesser wrote: | It's hard to understand that the most predatory industry in the | US is health care and people are OK with it. It's easier to deal | with loan sharks or used car dealers vs hospitals and health | insurance. | DangitBobby wrote: | I don't think people are okay with it. It seems very likely | that our politicians are bought and paid for and that's why | there's no one truly representing the public's interest. | paulgb wrote: | I don't understand how hospitals can ever expect a contract with | such ambiguous terms to be valid. Contract law requires a | "meeting of the minds" -- if they withhold price information | until after the service is performed, and the final price is | orders of magnitude higher than the expectation it's clear that | hasn't happened. | | Contract law is often seen as existing to protect the seller from | non-payment, but it equally exists to protect the buyer from | stuff like this, and it's absurd that these companies expect the | protection of contract law without giving their customers the | same benefit. | akomtu wrote: | It is this reason why I compare the US hospitals to white-shoe | mexican cartels. The latter use simple intimidation to take what | they want. Our hospitals identify a potential victim in need who | needs immediate help, and thus can't negotiate, force you to sign | a blank check (using verbal intimidation), force you to waive | your right for protection from racket (binding arbitration), lie | about costs (they call it a good faith estimate), then estimate | your net worth and demand half of that. When you refuse, they | send their white-shoe gangsters (lawyers) and take that half. A | carnival of greed and moral depravity. | indymike wrote: | > A carnival of greed and moral depravity. | | This seems to sum up the US healthcare system perfectly. | DangitBobby wrote: | > force you to sign a blank check (using verbal intimidation), | | Well, in many cases it's more than just verbal intimidation; | it's threat of imminent physical harm. | | You know that you won't get better terms by shopping around, | either. | czhu12 wrote: | Can anyone in healthcare on HN comment on how a surgery could | cost 229k? | | Really curious how that number breaks down in terms of equipment, | salary, medications, etc. | ceejayoz wrote: | It doesn't. Chargemaster rates are meant to be slashed 50-90% | when they get to the insurance company. | | We got a bill for $560 today that $500 worth just... | disappeared when insurance said "nah", because that's the deal | the two of them have. | | If you don't have insurance, or they pull the "it's not | covered" you get to fight the hospital yourself. | x-shadowban wrote: | It would be nice if this was the public debate we were having. | Recently they dragged oil company execs in for a light video chat | based grilling in the house. I would prefer to see the medical | insurance companies pilloried, but and for those pillorings to | yield something of substance. I imagine that every minute of talk | about abortion or immigration has the insurance companies and its | benefactors thinking "wow, we're still getting away with it!" | spaetzleesser wrote: | "I imagine that every minute of talk about abortion or | immigration has the insurance companies and its benefactors | thinking "wow, we're still getting away with it!"" | | That's how the US political system works. We are only allowed | to debate a small range of issues that don't affect the income | of the capitalists. | pcurve wrote: | In the U.S., insurance would reimburse upwards of $100k to | hospital for this procedure. | | The same procedure in Germany would cost $20-$30k. | | I guess that's why some insurance companies are paying for | medical tourism. | schappim wrote: | What would it take to "fix" the US hospital system, and prevent | others (the UK's NHS, Australia's public hospital's etc), from | falling into the same trap? | danielschonfeld wrote: | What will it finally take to cut this cancer called "healthcare" | in the United States? There is nothing promoting health or care | in it | motohagiography wrote: | We need a better black market for medical services at least there | is some honor among gangsters. These hospitals seem to be set up | to find people in duress and not merely rob them, but loot their | net worth. It's predation. | | Seriously, as a manual skill, how hard are 80% of superficial | surgeries really compared to learning an instrument or classical | music, learning to code, baking, cultivating a respectable golf | handicap, or getting good at a sport? It's hard to reconcile | stories like this with talking about health care workers as | heroes, when it sounds like people who work in US health care, if | they are not themselves, they at least work for someone who they | know is in fact, dispicable. | bastawhiz wrote: | Skilled piercers and body modification artists already perform | lots of "superficial" cosmetic procedures, sometimes for orders | of magnitude less than plastic surgeons would (which are, of | course, not covered by insurance). I've even seen some artists | correcting procedures that "real" doctors botched and wanted | even more money to fix--a common one is keloid removal. | tromp wrote: | > Before her surgery, Ms. French signed two service agreements | promising to pay "all charges of the hospital." | | > In Centura's view, the service agreements "were unambiguous and | French's agreement to pay 'all charges' 'could only mean' the | predetermined rates set by Centura's chargemaster," the court | said. | | > But the court found that Ms. French wasn't responsible for | paying those rates because she didn't know the chargemaster even | existed and hadn't agreed to its terms. | | > "Indeed, Centura representatives testified that the | chargemaster was not provided to patients, and in this very | litigation, Centura refused to produce its chargemaster to | French, contending that it was proprietary and a trade secret," | Justice Richard L. Gabriel wrote. | | Beyond ludicrous... | pevey wrote: | It's amazing that any of these "agreements" are ever upheld by | courts. As standard procedure, you have to agree to any and all | charges, but in most cases they refuse to give any estimate of | what those charges might be. They are "trade secrets." But if | you don't agree, you cannot get lifesaving care. It is | unconscionable. In this case, she is lucky they gave her that | insurance estimate. Usually they refuse specifically for the | reason of what happened in this case. They expect you to agree | to pay whatever they decide later. And people keep trying to | argue the US has a great healthcare system. It is beyond | broken. The very rich don't have to worry, the very poor don't | have to worry. The rest of us can get screwed if we have the | very bad luck of being US citizens who happen to get sick or | into an accident. | user3939382 wrote: | Totally agree. All these agreements are signed under duress | and ask the signer to agree to pay an amount while making it | impossible for the signer to know whether that's possible. | 88913527 wrote: | You can always try a different hospital for better service. | Of course this won't work in situations where timing is | critical, but most surgery is scheduled. We might as well | treat it for the business that it is. If they can't give you | a reasonable estimate up front, then don't sign the | paperwork. If they care about earning your money they will | negotiate with you, and it's always better to negotiate terms | up front proactively than deal with it reactively. The | strongest power a consumer has is to vote with their money. | patentatt wrote: | Maybe in some libertarian dream land only, not in reality. | You think a hospital will personally negotiate rates ahead | of time with a single patient? Absolutely fictitious. | polski-g wrote: | They could offer a flat rate based on the length of the | procedure... | AlotOfReading wrote: | You can try to comparison shop all you want, but _no_ | hospital will give you details in the chargemaster if they | aren 't legally obligated to. | | Even if you are in a position to shop around, journalists | have documented their futile attempts to do price | estimation for routine procedures. Here's one example: | https://youtu.be/Tct38KwROdw | | There have been recent laws that requiring publishing some | of that information (which are being heavily contested), | but comparison shopping remains effectively impossible in | the US. | Gention wrote: | You need to wake up and stop accepting this as normal or | okay. | | Hospitals are not just any business and if it starts to | hurt us as a society we need to interven. | est31 wrote: | > If they can't give you a reasonable estimate up front, | then don't sign the paperwork. | | That's the issue, they don't give you estimates that they | are actually bound by. | 88913527 wrote: | And if you're an hour away from being in the operating | theater, and they have all the specialists there, and in | that moment you choose not to sign-- it's more their | problem than yours. | Chris2048 wrote: | They'd likely ask you to sign way before that.. | FredPret wrote: | ...no it isn't? You _need_ to get surgery, they _want_ to | provide surgery | crooked-v wrote: | That's what makes it your problem. They can just say 'no' | until you sign the document agreeing to pay whatever they | bill you later. | OJFord wrote: | I think GGP commentor typo'd - it says the opposite at | time of writing. | BigBubbleButt wrote: | You're assuming the hospitals don't all do this. You're | basically discussing market dynamics with a legalized | cartel. | | This is like when people point out problems with fiat | currency which are very real, and then people suggest | theoretical solutions from cryptocurrency. It doesn't | actually help solve the problem in any meaningful way, and | you are living in an alternate reality from the problem | space we are discussing. | 88913527 wrote: | People say it's impossible to negotiate prices at modern | grocery chains. They only had brand name lactose | supplements. The manager gave me a hard time about it, I | asked about a price matching policy, shrugged, and let me | pay the generic price. I'm sharing this anecdote because | I don't think people try hard enough and you might be | surprised if you do. You won't win every time, but try | asserting some authority. | | By assuming markets are so rigged against you, it | discourages people from even trying. Price discovery can | only happen if you attempt to be firm. If you'll roll | over instantly, then sure, they can do as they wish. | BigBubbleButt wrote: | I've had the misfortune of suing insurance companies in | the past; I'm very aware of how the system works. You are | technically correct. It's just that you're grossly | exaggerating exceptions as though they will ever be | useful to a majority of people. | toss1 wrote: | No, you cannot | | I have no time to look it up RN, but I read a few years ago | about a new hospital President/CEO who literally could not | get a cost/price list for the services their hospital | provided - obviously a key management data set, yet it did | not exist. | | Just because you think something _SHOULD_ exist, does not | mean that it does. | JJMcJ wrote: | The cost accounting for most hospitals is totally opaque. | How do you assign overhead to each activity? Does the ER | make or lose money? | | How much of a nurse's time to give patient a Tylenol? | Zero? Five minutes? And how much does that nurse's time | actually cost the hospital? | | Nobody has the slightest idea. | bcrosby95 wrote: | I'm not sure it exists. Every hospital I've ever contacted | is a complete shitshow and can never accurately tell you | the price of something ahead of time. | | Dealing with our fertility doctor was great though. They | knew the price of everything. But they were ran out of an | office, not a hospital. | pevey wrote: | It's funny how anything elective or cosmetic is like | that. To be clear, infertility is a serious medical | condition, and I'm not making light of it. The | distinction I'm making is an economic one. When patients | have more choice as to whether to even be a patient, you | see much, much more consumer-friendly openness about | pricing. So it is possible. Fertility treatment is a | great example. So is elective eye surgery. These areas of | healthcare are very different from the "sign your life | away now and we'll send you the bill later" standard of | most healthcare. | lstodd wrote: | This reminds me of the situation with the telecoms in the | east europe - it's almost the same. There were no | incumbents, so both internet access and private | healthcare are leagues above US. It's just not | comparable. Also include online banking here. | | You need stuff done - you go and get it, end of the | story. No bullshit, no courts, no nothing, and it's | orders of magnitude cheaper. | JJMcJ wrote: | Dentists can usually give precise charges. | | Kaiser Permanente usually has a precise copay for just | about anything they do. So you have a good idea what the | charges will be going in. And nothing like an extra | $10,000 because one of the surgical team was "out of | network". | johnnyo wrote: | I tried this exact thing when my wife was going to have a | baby. | | None of the hospitals within 100 miles, the doctors, or the | the insurance company would give me so much as an estimate, | and this is for something that they do every day. | pclmulqdq wrote: | This whole nonsense with chargemasters is an industry | standard practice. It's hard to find a hospital that will | open the book for you. | chimeracoder wrote: | > And people keep trying to argue the US has a great | healthcare system | | I've never heard anyone argue that the billing and payment | aspects of the US healthcare system are great. | | I _have_ heard people argue that the quality of care (by | various metrics) or availability of services are great, but | that 's a different argument, and not mutually incompatible | with having a broken payment and billing infrastructure. | | > The very rich don't have to worry, the very poor don't have | to worry. | | I'm not sure how you're arriving at the conclusion that "the | very poor don't have to worry" | agiamas wrote: | agreed. You are under huge distress and don't have a viable | alternative and your life is in danger and you sign what is | really, a contract to pay with the amount to be paid being | blank. So essentially and legally speaking, how is this | different than blackmail? | SemanticStrengh wrote: | is there a limit? Can you legally enforce a hidden 1 | billion dollar debt to someone? | drdec wrote: | It would be dischargeable in bankruptcy so there is a | practical limit. | JJMcJ wrote: | Usually courts won't uphold "unconscionable" charges. | | Charge someone $1 billion to change a tire. Nope, nope, | nope, as an example. | prepend wrote: | > And people keep trying to argue the US has a great | healthcare system. | | I've never heard anyone argue this. The common argument is | that it really sucks and that proposed changes suck as well. | So the argument isn't "don't change because it's great." The | argument is "It's terrible and I'm worried that if you change | it, it will get worse." | tomxor wrote: | I've come across a number of people on HN claiming that | it's better than health care in other countries, or the EU | or UK. "other countries" is kind of meaningless, but I'd | argue it's pretty broken from what I've heard compared to | the UK, which while far from perfect, serves the majority | of people pretty well without bankrupting them. The EU | comprises many countries with varying quality of | healthcare, but I'd still be less uncomfortable in any EU | nation compared to the US because of my fear of it being | driven by corporate incentives, which can cost you more | than money (i'm sure there are some good counter examples, | nothing is perfect). | | I suspect those making broad claims that US healthcare is | better are able to pay quarter of a million without | blinking, and for them perhaps it is better - although they | still run the risk of unnecessary surgery no matter how | wealthy. | emilsedgh wrote: | Every time the Single Payer option is this discussed, you | hear people say how care in Canada and UK is broken, | indicating that it's fine in US, which is not the case. | bshep wrote: | I wonder what would happen if a patient swapped the form with | an identical looking form with different verbiage, making the | hospital responsible for any overage past what insurance would | pay. | | I very much doubt anyone would catch it until the bill was | contested later. What would a court say? Would it be as legally | binding as the standard document? | | Edit: Or imagine a disgruntled employee in the copy room | changing the form? | b3morales wrote: | The hospital would most likely have a very easy argument that | since it's not actually their standard form and you didn't | tell them about it, they didn't accept the agreement in any | way. And they'd probably try to get you for fraud as well. | | See also https://xkcd.com/1494/ | nrmitchi wrote: | So I guess the standard "you should have read the terms and | conditions before you signed the form" only applies in one | direction eh? | ajross wrote: | If you present a contract to the hospital and explain | that these are your terms, and a reasonably understood | officer of the business signs it, then sure: they're on | the hook. Contracts are contracts, and the law gives | great weight to consent, even in circumstances like this | where it's not clear a real negotiation happened. | | The idea above was about "swapping" some random document | in for the standard form and presenting it to them as if | it was their document. That's not good faith negotiation, | that's just fraud. | rowanG077 wrote: | If you gave back a different form and the hospital | doesn't bother to check it's their fault. Sending back | amended contracts back to back during negotiations is | completely normal. | resoluteteeth wrote: | There is a difference between informing them you are | modifying it or sending back a clearly edited version and | stealthily modifying it in the hopes that they won't | notice. | | I don't think it's going to hold up if you | surreptitiously modify it in bad faith. | drdec wrote: | You don't need the new document to hold up in court, the | gambit is to deprive them of having your legal agreement. | | Granted, a court might still see that as fraud, IANAL. | ajross wrote: | And again, refusing to sign a contract while presenting | to a business _as if you did_ for the purpose of getting | out of the payment agreement is simply fraud. It 's not | even arguable. | kadoban wrote: | Negotiating the terms of contracts isn't fraud. Neither is | refusing their insane terms, no matter how "standard" they | want you to believe they are. | brazzy wrote: | Swapping forms in secret is the opposite of negotiating. | jtc331 wrote: | It's not secret. This is standard contract negotiation | (sending along a new draft). | kadoban wrote: | That's true. But then again, "sign this or you're dead" | isn't negotiating either. | | The most honest behavior would probably be to mark | additions or changes on the form they give you, if | they'll fit. | ClumsyPilot wrote: | What do you mean in secret? The person explicitly talks | about providing the hospital with alternative agreement. | It is their responsebility to read everything they sign, | just like it is the patient's | Chris2048 wrote: | IF they sign first there's no way to do the switch: the new | form would be either missing their signature, or be an | (illegal) modification if original terms. | TheOtherHobbes wrote: | IANAL, but I suspect it's deceptive if the changes were | deliberately hidden and there is no notification of them. | | For example - if someone agreed a contract, changes are made, | and they were pressured to sign without reading the document. | | If changes are flagged and/or highlighted it would stand a | reasonable chance of being valid. Likewise if the patient | sent a cover email/letter saying "This is _my_ standard | contract. " | | Because these exchanges are bureaucratic, it's quite likely | the changes wouldn't be noted - or might possibly be | automated. | | It could be argued that's a failure of diligence by the | hospital rather than fraud. | | And it's also clearly unconscionable to expect patients to | sign a literal blank check with an open amount without | anything resembling a credible estimate. That's simply | unenforceable. | | All of this underlines why single-payer is the only viable | system. Without it a few people get extremely rich with huge | financial and social costs to everyone else - which is not | freedom, it's forced tribute and subsidy. | ipython wrote: | Can't do that at our local hospitals. The forms are all | computerized and your signature is captured on a small | tablet. | est31 wrote: | What protects you from _them_ swapping the forms then? All | you gave them was a picture of your signature, they could | add it to any form they 'd want. | missedthecue wrote: | There really isn't anything anyone can preemptively do | about someone else committing outright fraud. If that's | their intent, all they need to do is photocopy a paper | form with your signature on it, and move your signature | anywhere they want. | Peku wrote: | There is a story is someone doing something similar with | their credit card [1]. | | Not sure how well something like this would fly in the | states, but it would be interesting. | | [1] https://www.nasdaq.com/articles/updated-russian-man- | turns-ta... | Vecr wrote: | It would have to be signed by both sides to count. I've done | it before, but you can't just try to sneak things through if | they don't sign. | criddell wrote: | When I was registering as a new patient at a dentist, they | gave me the standard form that would let them do things | like contact my employer if I didn't pay my bill on time. I | stroked a bunch of that stuff out and initialed it. | | If it ended up in court and they produced that form, would | my amendments mean anything? Is it a contract when only one | part signs it? | bshep wrote: | In my experience these forms are only signed by patients, | so why are they valid in those cases? | lisper wrote: | The signatures _per se_ don 't really matter. What | matters in contract law is if there was an actual | agreement. The signatures are just evidence that there | was an actual agreement. They are neither necessary nor | sufficient. This is why verbal agreements can be binding | contracts, it's just that these are harder to enforce | because it's harder to show that a verbal agreement was | actually entered into. | DennisP wrote: | Well if the patient swapped the form, it would be pretty | clear they didn't actually agree to the terms of the | original form. | cperciva wrote: | And if they swap the form in secret in order to trick | surgeons into performing an operation which they haven't | agreed to pay for, it's pretty clear that they're | committing fraud. | jtc331 wrote: | People keep saying "in secret" but that'd only be true if | it happened after it were filed or some such. Giving | someone an amended contract isn't fraud. | cperciva wrote: | Giving someone an amended contract isn't fraud, no. | Giving someone an amended contract _while making them | think it hasn 't been amended_ is a different matter, | though. | rowanG077 wrote: | What do you mean "in secret"? The hospital received the | form in full detail. There is nothing secret about it. | It's like claiming the ToS are secret because none reads | it. | Chris2048 wrote: | > contending that it was proprietary and a trade secret | | surely once a patient gets a bill (preferably itemized) the | secret price of something is no longer secret. | | Further, what ensures there even is a consistent price if they | refuse to disclose it? | ryanSrich wrote: | There have been lots of discussions lately on various crypto | scams, but the biggest scam no one wants to fix is the American | health system. Until you've experienced it yourself it almost | sounds unbelievable how bad it is. Calling it a scam is an | understatement. | Havoc wrote: | US healthcare is a cruel joke. | | You even see this in international coverage - global except for | US. | | Though my current one excludes canada and caribbean too for | reasons I don't quite understand. Tainted by proximity perhaps | eecc wrote: | Ah thankfully it's not a Libertarian world yet, where the State's | only purpose is to guarantee the rule of law, and the freedom to | engage in whatever contract. | wafriedemann wrote: | "hospital (...) told her she would be personally responsible for | paying about $1,337" | | LUL 1337 scammers | ed25519FUUU wrote: | No good precedent set with this case. Hospitals will simply | update their service terms to be really clear that you're | agreeing to what the "chargemaster" says you owe. They'll mention | it like 5 times so they don't lose on these terms again. | | Really a shame. | DangitBobby wrote: | The judge specifically mentioned that they chargemaster is not | shared with the patient as a protected trade secret, so I think | this sets a precedent that you can't be held to terms about | price if you aren't going to disclose the price. | upbeat_general wrote: | These are the extreme cases but this happens all the time, | including to myself (albeit only for a few hundred dollars). | | It's shocking that somehow the system we've come to amounts to | "we don't know the cost, we'll talk to your insurance after and | bill you some amount." | nopenopenopeno wrote: | It's not that shocking if we take seriously the logical | conclusions of a society that mediates relations between people | by way of their relations to capital, i.e. capitalism. | | Insofar as the domestic American economy functions as the core | of a global empire, it is uniquely prone to these seemingly | nonsensical conclusions. The United States is on its 4th | generation into being the most unchecked industrial capitalist | empire in history. I think it would actually be more surprising | if we had a sensical healthcare system. | dahfizz wrote: | When my car breaks, a mechanic can give me a detailed | estimate which is very close to the final cost every time. | | There is no reason inherint to capitalism that healthcare | couldn't work the same. Every other industry under capitalism | has sane billing practices. | | Regardless, healthcare is far from being an "unchecked" free | market. The government deals more in healthcare than any | other market, except maybe student loans. | dghlsakjg wrote: | Car mechanics are also bound by estimate accuracy laws in | many states. If they go over without approval then they | aren't entitled to more money. | | I understand that medicine and mechanics aren't the same | thing, but I also have gotten elective procedures where the | cost, down to the penny, was quoted up front. | BlackjackCF wrote: | Yeah, it's either that or "we'll cover what we think is a | _reasonable amount_ for your zip code ". Which is usually | SEVERELY UNDER the market rate in that area. | | As an American, I was shocked when I lived in Ireland and saw | prices for stuff upfront. | Fernicia wrote: | Getting stuff done privately in Ireland is great and fairly | cheap. But relying on the HSE can leave you waiting years for | basic treatment. | throwaway742 wrote: | Actual quoted cost was 1,337. | | Nice. | PragmaticPulp wrote: | Some good news: As of 2022, we have a new "No Surprise Billing" | law that covers many of these surprise billing scenarios. There | is a specific provision for being charged significantly ($400) | more than a "good faith estimate" | | More detail about the No Surprise Billing law here: | https://www.cms.gov/newsroom/fact-sheets/no-surprises-unders... | | Sadly this case occurred prior to the law going into effect. | JamesUtah07 wrote: | I'm worried that the hospital forms will start to include a | clause to agree to "waive" the affects of this bill | DangitBobby wrote: | Seems to me that ultimately this will have little to no effect | since they gave them an escape route. | | > Require that health care providers and facilities give you an | easy-to-understand notice explaining the applicable billing | protections, who to contact if you have concerns that a | provider or facility has violated the protections, and that | patient consent is required to waive billing protections (i.e., | you must receive notice of and consent to being balance billed | by an out-of-network provider). | | All hospitals will simply make you wave your rights as part of | their onboarding process. These rights need to be something | that cannot be waived or they actually just add more work for | hospitals (ie, more cost for patients) and more work for | patients. | | Edit: After further reading, in all emergency care scenarios | and certain non-emergency care scenarios, they cannot ask you | to waive these protections. Though, I wonder who gets to decide | if it was an emergency? Certainly not the patient. | asperous wrote: | The disappointing thing to me is all the time spent on this case: | lawyers, administrators, jury members, and so on that could be | doing something different, hopefully more meaningful to society. | | People blame the hospitals but this the game they have to play in | order to cover their costs [1]. Just seems like a tremendous | waste of resources and social cost. | | https://truecostofhealthcare.org/hospital_financial_analysis... | joe_the_user wrote: | _People blame the hospitals but this the game they have to play | in order to cover their costs..._ | | If you do things that literally ruin people's live, I don't | care if you "have to do it" to keep your business going. | | As to lawyers, in a society with money and contracts, these | exist. What I would hope for would be a statue with in the case | of the abusive billing, the victim can sue for ten times the | amount of the bill, just for starters. | macintux wrote: | I'd be curious how much money is spent each year on the | bureaucracy of healthcare, from employees who do little besides | manage health insurance, insurance company employees, billing | specialists in medical establishments, etc, etc, etc. | ktzar wrote: | Private medical services are a very profitable business for | certain professions that buzz around doctors and nurses. People | without knowledge about medicine and whose only interest is a | private company's benefit. | PaywallBuster wrote: | > Hospitals over-bill persistently and excessively to the point | where hospital billing charges have ceased to have much meaning | beyond their ability to shock and frighten people. The | | > While Medicare and Medicaid control their costs by tying | their payments to the actual cost of medical services, private | insurance companies appear to be just paying a fixed percentage | of what they're billed. That alone gives hospitals a strong | motivation to inflate their billing charges by more each year | independent of their costs. | geoduck14 wrote: | Medicare isn't that great, too. My wife worked health care | and Medicare patients were difficult because of the weird | paperwork | lr4444lr wrote: | Very few medical practices or hospitals can survive solely on | patients paying Medicare rates. | planetsprite wrote: | This is true. Capitalism is at it's best when it manageably | distributes supply and demand forces in a minimal surface, | maximizing net utility via the price level and transactions. | It's at its worst when those at one side of the transactions | (healthcare buyers) are systematically denied information and | held hostage via contracts. | | The American healthcare system operates on this, and it's such | a valuable tactic that it's worth more to waste resources on | managing this degree of litigation than just charge reasonable | amounts. | | In more cases on average, the healthcare providers must be | making a net profit via these tactics, otherwise they wouldn't | do it. The fact that this tactic is even theoretically | profitable means the system is fundamentally broken. | thr0wawayf00 wrote: | As long as the public isn't interested in seriously considering | alternative systems like Medicare for All, nothing is going to | change. | | There's a reason that private equity has consumed our | healthcare sector: it's incredibly lucrative and inherently | disadvantages both the patient and provider through vast | amounts of process. | | Pretty much every healthcare startup in the US is just trying | to figure out how to insert itself into this endless | bureaucracy and draw money out of the system while trying to | add value in some way. | gedy wrote: | Thing is, we didn't have socialized medicine in say the | 1970s, and I don't remember things being this bad or | regulated. What happened? | Epa095 wrote: | Maybe just "time" happened? It takes time for the rot to | properly develop. | pooper wrote: | >> Thing is, we didn't have socialized medicine in say | the 1970s, and I don't remember things being this bad or | regulated. What happened? | | Or even more simply, we grew up. I was born in the late | eighties. I was simply too young to understand that the | civil war was not about states' rights. It was about | slavery. I thought adults knew everything and as I became | an adult I realized I knew nothing. | | That or a lot of what was previously swept under the | carpet or dog whistled is now out in the open. | | Back to the topic though, I agree with you Probably the | easiest explanation is healthcare is now a bigger slice | of a bigger pie about 20% of a USD 20T GDP iirc. There is | simply too much money to be made here. There is only so | much investment opportunity that has any good return so | smart money will chase anything that resembles guaranteed | returns. | | Thoughts? | WoahNoun wrote: | EMTALA was passed under the Reagan administration. This | forced hospitals to treat the uninsured, but it provided no | funding to pay for those treatments. So the uninsured who | don't pay are subsidized by high costs to the insured who | do pay. In the 1970's, hospitals would just let the | uninsured die in the parking lot / street. | | So that's the change. | | https://en.wikipedia.org/wiki/Emergency_Medical_Treatment_a | n... | spaetzleesser wrote: | "This forced hospitals to treat the uninsured, but it | provided no funding to pay for those treatments. So the | uninsured who don't pay are subsidized by high costs to | the insured who do pay. " | | They are way overcompensating for this. I think it's just | a BS excuse like pharmaceuticals having to be | outrageously expensive in the US because other countries | are negotiating better prices. I have read some studies | where they concluded that the losses through uninsured | people aren't really that high. They are only high on | paper because they account for them with their | chargemaster prices which are way higher than what they | would get from insured people. | spaetzleesser wrote: | Greed happened. Hospitals consolidated and bought up small | practices. | thr0wawayf00 wrote: | There are a ton of reasons why, but here are a couple of | the big ones. | | The US is still at the forefront of medical research and | technology development in the world. However, many other | countries won't pay "market" rates for newer technology | developed here at home, so companies often overcharge | domestically as a way to recoup revenue they can't collect | in other places. Note that American hospitals (particularly | newer ones) tend to be obsessed with having state-of-the- | art technology, and they're damn sure gonna get paid for | that. | | Another major factor driving healthcare costs is the | increasing barriers to access for millions of people. Lots | of folks don't realize this, but the US already has a | quasi-socialized healthcare system mandated through Federal | law. Basically, it's illegal for hospitals to turn ER | patients away that cannot prove ability to pay, so folks | without insurance often come to the ER for routine medical | treatment because its the only way they can be seen, and | they know the hospital isn't going to chase them down for | their bill because they can't pay for it anyway. Who winds | up eating those extra costs? Folks with insurance. I used | to work in an ER and I saw this happen all the time. | joe_the_user wrote: | The glory days of the semi-welfare state in the US were | indeed the 1950s-to-mid-1970s. A lot of those were | regulated monopolies - in the case of health care, Blue | Shield was a single, private but regulated insurance | company owned by hospitals (some portion of which weren't | for-profit). The main way Blue Shield was regulated (and it | was definitely regulated) was it allowed to maintain | complete control of the health insurance market, so that it | operated like "single payer" without officially being | "socialized medicine". The elimination of this system | indeed brought us to the disaster that we're looking at | now. | kevin_thibedeau wrote: | Boomers are old enough now to fuel the growth of medical | profiteering. In the 70's 65+ was 10% of the total | population and they spent less time in that age bracket | before death. Now they're 16% and living longer. | [deleted] | DennisP wrote: | There are quite a few countries that do not have single-payer | and do just fine. According to the book _The Healing of | America_ , these include France, Germany, and Japan, all of | which get top-ranked results at much lower cost. The key | difference is that the government sets the price list for all | services. | | That would be a big change for the US, but not as big as | nationalizing the entire industry. | misslibby wrote: | "doing fine" is a pretty bold claim. I doubt there is a | healthcare system without issues. Germany is changing a | lot, and not for the better, because the system was not | really sustainable as it was. | DennisP wrote: | Well ok, "doing among the best in the world, as of the | book's publication." If our standard is perfection then | nobody measures up. | joe_the_user wrote: | Public support isn't the question. The public does support | Medicare For All[1] but that doesn't matter given the | election and decision making process of congress - | essentially that it's controlled by forces that profit from | the present system. | | https://morningconsult.com/2021/03/24/medicare-for-all- | publi... | toomuchtodo wrote: | This 100%. You have to flush out the reps who won't vote | for it regardless of constituent support and desire. | Determine how many you need to replace, identify the | weakest incumbents/most likely races to win, select | challengers, fund them, and you hopefully unfuck US | healthcare in the end. Maybe you need a few candidates to | pull a "reverse Sinema"; run as a Republican, win, and then | turncoat and vote for Medicare for All (with the | understanding you're probably only serving one term, but | who cares if you get the policy done, 1.8 million voters | over the age of 55 die every year, you're just pulling | progress forward with some political sacrifice versus | waiting for cohort succession). Politics hacking and social | engineering at its core. | | If you're not one to wait, the only other option is moving | to a better country. | hemreldop wrote: | confidantlake wrote: | Value optional. | spaetzleesser wrote: | "As long as the public isn't interested in seriously | considering alternative systems like Medicare for All, | nothing is going to change." | | I resent the Democrats and Biden for not embracing Medicare | For All. This would be the most straightforward path to a | halfway sane system. | khuey wrote: | Even if they did completely embrace it it still wouldn't be | happening. There are plenty of current Democratic Party | priorities that are dead on arrival in the Senate. | mikeyouse wrote: | You can pretend like they're the problem and resent them as | much as you want but which 10 Republican senators are going | to vote with the Democrats? It's endlessly frustrating when | ~48/50 democrats would vote for something and 0/50 | Republicans and people either "both sides" it or | inexplicably blame the democrats? | amelius wrote: | It's a shame that the Hippocratic oath didn't contain the | sentence "I shall not overcharge my clients or bring them in | financial jeopardy". | UnpossibleJim wrote: | It isn't doctors who do this. Doctors, by and large, would | love to just treat people. And while doctors do make quite a | bit compared to other countries [1], the litigious nature of | the American patient and the high cost of education make | these wages almost a necessity in order to pay off insurance | and student loans =[ | | https://www.investopedia.com/articles/personal- | finance/08061... | criddell wrote: | The AMA is a professional organization for doctors and they | have opposed all kinds of changes designed to reduce | medical costs because it would hurt their members' bottom | line. | | The system is a racket and doctors are in on it. | alamortsubite wrote: | > The system is a racket and doctors are in on it. | | This is a bit much. You're right that the AMA is a big | part of the problem, but fewer than 1 in 5 U.S. doctors | are paying AMA members. [1] That's down from about 75% in | the 1950s. | | [1] https://www.physiciansweekly.com/is-the-ama-really- | the-voice... | epistasis wrote: | Doctors are also very self-interested and want to advance | their careers. | | So if the top surgeons at a hospital want the newest, most | expensive toys, and will leave for another hospital unless | they get them, it might be that the hospital administrators | buy unnecessary machines just to keep their best people | around, at the cost of increased bills for everyone. | | In this story, the surgeons may not be explicitly greedy, | but the system sets them up to cost everyone quite a bit. | bradleyjg wrote: | How true is that really? What's the difference in lifetime | earnings between a UK and US orthopedic surgeon net of | insurance and loan payments? | | My sense is that the difference in pay dwarfs the | difference in costs. | bradleyjg wrote: | Covering their costs is a bs framework. Hospitals are de facto | partnerships run for the benefit of certain insider employees. | Their "costs" are whatever the market will bear paid to those | same employees. | | Ditto for universities. | vinyl7 wrote: | Universities get away with absurd pricing because the | government guarantees the loans. If the govt stopped backing | the loans, the tuition costs would plummet and the govt | wouldn't need to back them anyway. | robin_reala wrote: | They don't have to play this game. For reference, see most | other countries who have taken the slightly more enlightened | step of a socialised healthcare system. | Chris2048 wrote: | It's kind of useless to say this an not name at least one | such country. Notably, many of the places with "better" | healthcare aren't obviously sustainable e.g. France. | markus_zhang wrote: | This is the nature of the US society. | [deleted] | nobodyandproud wrote: | Your own link disagrees with your conclusion. | quadrifoliate wrote: | The biggest problem here is this "full cost, because it was out- | of-network" nonsense. I don't understand how healthcare networks | are legal - they essentially create two separate medical systems, | one of might not accept your so-called "insurance" at all. | | I know that universal coverage is a pipe dream in the US, but | making these coverage networks illegal and forcing insurers to | cover procedures at the same rate regardless of network would be | a good first step. And it _should_ be a bipartisan issue as well, | somehow I don 't see conservatives clamoring to keep paying | higher prices for ambiguously defined "networks". | yes_really wrote: | The most revolting part of the US medical system IMO is the | complete lack of transparency in prices. | | In the ideal case, people would know what they would pay in each | hospital when they are still deciding where to go. | otikik wrote: | Single player now | jokoon wrote: | It still boggles my mind how the US is the "first world power", | and yet there is so much gun violence, those healthcare problems, | homelessness, high co2 per capita, obesity, the prison system | (especially in Louisiana where it's almost still slavery for | inmates), money in politics, inability to get abortion... | | All those issues are usually found in third world of developing | countries, so I'm often quite confused... | 22SAS wrote: | >Obesity | | Sadly, in the US, there're obese people who're strongly into | nonsensical movements like HAES (Healthy At Every Size), fat | positivity. They think being obese is good, healthy, and doing | nothing to address is a great thing. If one so happens to tell | them about the health risks due to obesity, they are termed as | fatphobic. | DangitBobby wrote: | Surpisingly it's easier to just un-learn what you know about | personal health to protect your self-image than it is to lose | weight and keep it off. I say this as someone who has lost | weight and kept it off. | DangitBobby wrote: | From the inside, it very much feels like the decline of an | empire. We're really getting it from all sides, and people just | in general seem pretty unhinged. | albertopv wrote: | There are many things for which I envy USA, health care system is | not one of them, not at all. | [deleted] ___________________________________________________________________ (page generated 2022-05-21 23:00 UTC)