Pro tip: I was a neurosurgical anesthesiologist at the University of Virginia Health Sciences Center for twelve years (1983-1995). Every now and then I'd get a call from our billing office that they'd received a letter from a patient I'd cared for who was too poor to pay what our department had billed (usually many thousands of dollars: I had NO IDEA what our charges were, BTW, nor did any of my colleagues in the department). Every time that happened, I'd go over to the billing office and — without bothering to read the letter — tell our billing chief to waive all anesthesia-related charges. In other words, by my initialing a form we had, their balance due us was 0. Try it, you never know, it might work for you.
If you are a patient in this situation, there are advocates who can help you. One thing to try is to ask the billing department if they will "accept assignment". What that means is that instead of billing you their fake rate, they would instead bill you as if you were an insurer.
IMO, it is incredibly unethical and dishonest for these medical corporations to charge different fees depending on who you are. Prices should be transparent, and should be the same for everyone.
Some may argue that an organization representing a large pool of people should be able to achieve economy of scale and a better price. This seems false to me, as in reality there is only one pool of people and care provider provide care to that one pool. Its time to kick the middlemen out.
I've done that. Except I didn't know the words "accept assignment". I basically just said that I'd pay whatever they'd charge if I had insurance. So they could either accept that, or let it go to collection. And if they let it go to collection, I argued, they'd probably get less than the insurance price that I'd pay them.
God this a thousand times. How in the /fuck/ have we allowed our medical system to come to this?
I get the negotiation side of things. I get that the leverage insurance companies have is the culprit. But at the end of the day, hospitals just upcharge so they have the upper hand in negotiation. There’s no reason that individuals who choose not to go the insurance route are artificially charge X times what insurance companies are. There’s no excuse.
Charge them the cost of the procedures with whatever markup is reasonable for the hospital to stay in business. It shouldn’t be any other way.
Middlemen are not indispensable - they need to justify their existence not others to justify their absence. The whole point of cutting out the middlemen is to force them to go from a parasitic role to offer some sort of actual utility for their price.
If the middlemen have something of value to offer they have little to fear - just someone to buy gasoline by the tanker for instance keeps gas station middle-men safe because they provide both a workable connection between logistics of the very large production and consumer scale amounts - in addition to the distribution.
My experience is that hospitals have switched to a zero tolerance policy around this in the last few years. They'd rather make no concessions and sell bad debt for pennies on the dollar than set a precedent that there are alternative channels of payment. The one lifeline they give you is an interest free loan. From an economic standpoint, I'm sure this optimizes revenue. From a humanitarian standpoint, it's disturbing. I'm not arguing healthcare should be free or discounted, but when you receive a $500 bill because the on-call ambulance wasn't in network (though the others are in-network and would have cost you $50) it is hard to justify zero tolerance. We have a gold plan and I can't count the times we've been subject to loophole fees like this.
I'm sure this is true. We've (unfortunately) now experienced this at 4 different hospital systems. The customer service is alarmingly similar.
Hospital: "Call your insurance company and ask for a break"
Insurance Company: "Call the hospital and ask for a break"
Also, 2/4 of these hospitals had outsourced their billing which means they can't even make decisions on behalf of the hospital (and have a disincentive to write anything off). Seems like a structural way of avoiding writedowns.
Was going to ask about outsourcing. I don't know the market on provider billing, but I'd assume there are some companies that manage a number of facilities.
Thank you for doing that. As somebody who has recently received a discount from their dentist on an emergency procedure, I can't begin to tell you how much we as patients appreciate these acts of consideration and kindness. Even if we can't fix the larger, systemic problems in healthcare right now, these individual acts of kindness can really make a big difference in somebody's life.
Doctors don't know the prices, and neither do the customers (not without doing a lot of homework that can't be done during emergencies). Even when you know the list prices, the actual prices your insurance negotiates are almost certainly different, so asking for list prices isn't enough.
Basically, in the U.S. the healthcare system is not exactly a free market as pricing signals are unclear, and most consumers have no idea how or inclination to price shop as they have been trained for decades to not bother. The problem is now not just a matter of how insurance is structured, but cultural.
My wife owns and operates a private medical practice (she's an audiologist), and it's insane the way she has to do billing and accounts receivable.
When a patient asks about prices she quotes them her standard price for the necessary services and calls their insurance company to confirm that the patient is covered and check what kind of copay the patient needs to pay. Assuming the patient is satisfied with the results of that call she provides the services, bills the patient for their copay, and files a claim with their insurance company.
Several months later (and no real way to predict when), the insurance company will provide an "offer" for probably somewhere around 60% of the quoted price (though this varies dramatically as well). She can accept the offer, in which case she's inevitably required by the terms to eat the difference instead of attempting to collect the balance from the patient. Or she can reject it and attempt to collect from the patient, in which case they will likely be very confused and angry as to why their insurance isn't being accepted, despite her explicitly confirming that it would be covered before they purchased her services.
To be clear, none of this is negotiated or agreed upon in any meaningful sense. She doesn't have any special relationship with any insurance provider. Instead, the providers use their massive power differential to dictate terms. She wouldn't be able to stay in business if she didn't accept at least some insurance, but they'd be quite happy to never write her another check.
She knows what her price schedule for everything is, but it doesn't end up mattering that much since she doesn't know when or how much she'll ultimately be reimbursed except in an extremely broad aggregate sense. The worst part is that she has to dramatically overprice her services so that she can ultimately get adequately reimbursed to keep the lights on, which just ends up hurting the patients who don't have insurance.
In a world of pre-1990s, high-deductible, 80/20 insurance, this would happen less as the insurance company might not do the 800lb gorilla thing until the patient maxes their deductibles, and high deductibles give the consumer a strong incentive to negotiate directly with the provider.
It's insane more people haven't realized this. All you need to do to fix our healthcare system is bring transparency to prices and have insurance actually be insurance again instead of health plans. I have multiple anecdotes from my own life where I didn't care about the cost of something due to my insurance paying for it (and in some instances not being able to be informed of the price beforehand). When you have a whole country like that it's easy to see how things have gotten to this point.
The only downside is I don't see how it would fly politically...which is a big downside.
The counterexample is Medicare and Medicaid, which (CMS particularly) are exhaustively transparent (to provider and patient alike) regarding what they cover, pricing schedules, etc. Having architected revenue cycle platforms, I can say that Medicare was almost ridiculously easy to work compared to private carriers.
Yes, but that would require lower costs (prices). That we could get if pricing were more transparent. I believe that will require moving back to high-deductible 80/20 style insurance.
This was my experience when my partner received treatment and the insurance company refused to cover the anesthesia charges (they claimed anesthesia was optional for the procedure and thus wasn't covered). The anesthesiologist's office was surprised that it wasn't covered and waived the charges.
It was the only bright spot in a prolonged battle with the insurance company and the hospital.
Another big tip: if you need an X-Ray or any kind of exam done, don't do it in a hospital. Go to a clinic (if applicable of course) that specializes in those kind of exams and is covered by your insurance company if you can, it will cost a lot less usually. You can usually call your primary and ask them what clinics or labs they recommend. You'd be surprised what a huge difference that makes.
After we establish transparent pricing across the board, we're going to have to deal with the reality that some folks seek care without having any ability to pay for services.
Yes, we will, and that will hopefully lead to a more important conversation about what the priorities of a society's medical system should really be, or how a society should prioritize funding medical services if you want to take a different approach.
As I recall, every fellow attending did exactly what I did whenever they received a letter like that. It happened so infrequently, and our department billed so many tens of millions of dollars/year, it wasn't even a ripple in the pond.
After thinking about this, I realized he probably didn't do the job for free. Even though "anesthesia" is broken out as a line item on the bill from the hospital, it's not what the anesthesiologist gets paid. It's probably not a passed-through charge like it appears to be.
