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I am Ram

Surprise medical bills

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https://www.nytimes.com/2020/02/14/opinion/sunday/surprise-medical-billing.html

https://www.npr.org/sections/health-shots/2020/02/12/804943655/doctors-push-back-as-congress-takes-aim-at-surprise-medical-bills

https://www.marketwatch.com/story/1-in-5-americans-get-hit-with-a-2000-surprise-medical-bill-after-elective-surgery-study-says-2020-02-12

https://thehill.com/policy/healthcare/482593-house-panel-advances-bipartisan-surprise-billing-legislation-despite

https://www.theatlantic.com/health/archive/2020/02/surprise-bills-can-come-even-when-hospital-and-surgeon-network/606391/

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Typical scenarios: A patient having a heart attack is taken by ambulance to the nearest hospital and gets hit with a bill of over $100,000 because that hospital wasn’t in his insurance network. A patient selects an in-network provider for a minor procedure, like a colonoscopy, only to be billed thousands for the out-of-network anesthesiologist and pathologist who participated.

Lots of discussion, lots of proposed legislation, but as usual, no clear path to fixing the issue. Anyone here been hit with nasty surprise bills?

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3 hours ago, mysfit said:

So far no.

 

I'll let you know after my back surgery. 

Might want to do this rather than signing that you'll pay whatever amount they can come up with: https://www.nytimes.com/2020/02/06/well/a-possible-strategy-for-fending-off-surprise-medical-bills.html

Good luck to both your back and your wallet!

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1 hour ago, Bob said:

Price transparency would be a good place to start

And significant deductibles, say $1 - 2 thousand per year so people have skin in the game.  

As for original topic, it is bullshit.  If you go to a network hospital, all services should be billed at network prices.  Life threatening emergency should be covered at network rates to patient when traveling outside home location.

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58 minutes ago, modestobulldog said:

And significant deductibles, say $1 - 2 thousand per year so people have skin in the game.  

As for original topic, it is bullshit.  If you go to a network hospital, all services should be billed at network prices.  Life threatening emergency should be covered at network rates to patient when traveling outside home location.

"significant deductibles"? modesto have you looked at any employer operated insurance lately? I've never had a deductible under 5k/year. 

Remember that every argument you have with someone on MWCboard is actually the continuation of a different argument they had with someone else also on MWCboard. 

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43 minutes ago, happycamper said:

"significant deductibles"? modesto have you looked at any employer operated insurance lately? I've never had a deductible under 5k/year. 

Family or individual? I was inferring individual.  I switched to a high deductible plan over a year ago.  I wish it was available much sooner so I could have funded more into HSA.  I didn't get started until age 61.

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Just now, modestobulldog said:

Family or individual? I was inferring individual.  I switched to a high deductible plan over a year ago.  I wish it was available much sooner so I could have funded more into HSA.  I didn't get started until age 61.

Individual. 8k family. 

Remember that every argument you have with someone on MWCboard is actually the continuation of a different argument they had with someone else also on MWCboard. 

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30 minutes ago, happycamper said:

Individual. 8k family. 

Whew, that is rough.  Does employer contribute to HSA?  My employer started offering HSA a few years ago, was paying a little over $200 / month for Anthem Blue Cross ppo, employee plus (grand)children plan.  With high-deductable plan, no premium, and company contribute $750 per year to HSA. I forget how much individual deductible, but family out of pocket is $5 k.

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2 hours ago, modestobulldog said:

And significant deductibles, say $1 - 2 thousand per year so people have skin in the game.  

As for original topic, it is bullshit.  If you go to a network hospital, all services should be billed at network prices.  Life threatening emergency should be covered at network rates to patient when traveling outside home location.

Obamacare did this already. 1000% increase in my deductible, 3X increase in my premium.

For The Greater Good, I'm told.

 

“Science is the belief in the ignorance of experts.”

-Richard Feynman

"When buying and selling are controlled by legislation, the first things to be bought and sold are legislators."

-P.J. O’Rourke

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10 minutes ago, modestobulldog said:

Whew, that is rough.  Does employer contribute to HSA?  My employer started offering HSA a few years ago, was paying a little over $200 / month for Anthem Blue Cross ppo, employee plus (grand)children plan.  With high-deductable plan, no premium, and company contribute $750 per year to HSA. I forget how much individual deductible, but family out of pocket is $5 k.

Not here. First job did, I doubt they still do. It's especially rough in the marketplace. Washington is better, but in Wyoming we had the option to pay ~700 bucks a month to have a 7500$ individual deductible. Prices were insane enough that self insurance (AKA emergency rooms and don't get sick) made more sense. 

Marketplace is mostly broken with these costs. 

Remember that every argument you have with someone on MWCboard is actually the continuation of a different argument they had with someone else also on MWCboard. 

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Just now, happycamper said:

Not here. First job did, I doubt they still do. It's especially rough in the marketplace. Washington is better, but in Wyoming we had the option to pay ~700 bucks a month to have a 7500$ individual deductible. Prices were insane enough that self insurance (AKA emergency rooms and don't get sick) made more sense. 

Marketplace is mostly broken with these costs. 

I agree, I was fortunate to work for a fortune 500 with significant above average health and retiree benefits.

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15 hours ago, Akkula said:

I googled the term "gurney capitalism" but nothing came up.   I may have just invented a new term:cheer:

But that idea is basically what the USA medical system...

godfather GIF

I’m trademarking that :ph34r:

thelawlorfaithful, on 31 Dec 2012 - 04:01 AM, said:One of the rules I live by: never underestimate a man in a dandy looking sweater

 

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14 hours ago, modestobulldog said:

As for original topic, it is bullshit.  If you go to a network hospital, all services should be billed at network prices.  Life threatening emergency should be covered at network rates to patient when traveling outside home location.

You'd think that's the whole point of having these networks in the first place...

Couple of years ago, I had some sinus surgery. I checked the explanations of benefits and the final bill (that came in various small and large portions over the couple of several months) pretty thoroughly. There weren't any out-of-network items, but there were a few really oddities that I decided to follow up on, most notably some mysterious throat injury that they treated. I called the hospital, I called the surgeon's office, and I called the insurance people - no one was able to tell me what the nature of the injury or the treatment was. Again, I was in for sinus stuff. My theory is that it was something minor related to the ventilator they used while I was under, but the lack of transparency at my so-called "medical home" was absolutely infuriating. 

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On 2/17/2020 at 10:39 PM, I am Ram said:

You'd think that's the whole point of having these networks in the first place...

Couple of years ago, I had some sinus surgery. I checked the explanations of benefits and the final bill (that came in various small and large portions over the couple of several months) pretty thoroughly. There weren't any out-of-network items, but there were a few really oddities that I decided to follow up on, most notably some mysterious throat injury that they treated. I called the hospital, I called the surgeon's office, and I called the insurance people - no one was able to tell me what the nature of the injury or the treatment was. Again, I was in for sinus stuff. My theory is that it was something minor related to the ventilator they used while I was under, but the lack of transparency at my so-called "medical home" was absolutely infuriating. 

The coding used is sometimes misleading.

 

I had something similar with my ankle surgery and asked my Dr. He said it was the closest code to something he had done with the tendin repair even though the description didn't really match.

One of the Final Five..........

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On 2/17/2020 at 9:25 AM, happycamper said:

"significant deductibles"? modesto have you looked at any employer operated insurance lately? I've never had a deductible under 5k/year. 

I was looking around for new jobs a while ago until I realized how good I actually have it. Personal deductible: $500, family: $1,000. Premiums are 100% covered by my employer.

 

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