> Long story short, the hospital made up its own rules, its own prices, and figured it could just grab money from unsophisticated people
This is the core truth that all of healthcare in the US spins out from. A few personal experiences which back this up:
1. I received a $1500 bill because an ambulance that was sent when I called 911 was an "out of network ambulance". I looked it up: One small ambulance company in SF is in-network with that insurer. The SFFD runs the vast majority of ambulances and is "out of network." Insurance companies of course are not allowed to penalize you for accepting the first ambulance that arrives in an emergency. I filed a formal complaint with the California regulator that regulates that insurer and within 2 weeks the bill had been properly taken care of.
2. Our family has met its family Out of Pocket Maximum this year. Twice in the past month I've had doctor's offices lie to me and say that we still have to pay a copay. The last one claimed "well, you still have to meet your individual one though." Lie. That's literally the opposite of the way it works. We've paid copays to these people accidentally in previous years and they would never give the money back, they just keep it and also double dip since insurance pays them anyway.
In all cases, both hospitals and insurance companies simply ask for the maximum possible thing they can ask for, knowing that a frightening majority of people are afraid of them, and will pay whatever they're told. In OP's case, an unsophisticated payer would have gotten a $195k bill, been sent to collections, the hospital would have sold the bad debt, and then the person would have maybe "gotten a good deal" by getting it cut down to $50k over many years of high-interest payments and having ruined credit.
Insurance and hospitals are both filthy, money-grubbing machines. To paraphrase a famous cartoon character, their business is bad and they should feel bad.
I find it curious that people are celebrating when they manage to not pay (part of) an absurdly wrong bill that can only be either the result of gross incompetence or- much more probably- an attempt at fraud. The actual happy ending of such a story would be that the healthcare provider is sued for damages and/ or attempted fraud, and has to pay back a large multiple of what has asked.
Can you elaborate a little on point 1? I also somewhat recently had an expensive ambulance ride in SF that I'm dealing with - Insurance told me it was out of network, but would negotiate down on my behalf. They were able to negotiate away most of the bill, but since then the ambulance company has just come back to me asking for all of the money that the insurance company had told me they negotiated out of the bill.
I'm always happy to help people stick it to crooks. Here's what I know:
The California Department of Insurance may be the regulator for your health insurer, but it may not be. If not, it's the Department of Managed Health Care. You should be able to find a reference to who their regulator is in their plan documents.
My original ambulance thing was with an insurer regulated by DOI. Much more recently than my original story, I went to file with CDMHC, which requires that you first file a formal grievance with your health insurer first. I would definitely recommend to file a grievance. In my case, I filed a grievance and also contacted the office of the CEO, who emailed back and miraculously made another made-up problem go away even faster than the grievance process did.
But anyway, yours is an interesting case here. I can't be sure if the insurer is the one who screwed up here, also the ambulance company may not be allowed to balance bill you. The only thing I'm pretty sure of is that you shouldn't be responsible for more than an in-network ambulance would cost you, presuming you didn't just take an ambulance in a non-emergency, just for fun (as they seem to always assume).
Surprise ambulance bills are mostly (but not completely) illegal in California as of Jan 1 2024. Ask the LLM of your choice about AB 716 and whether it applies to your situation (it likely but not certainly does). Have the LLM draft a letter and send the physical letter to the ambulance company. If they are bothering you, request they only contact you by US mail.
This is the core truth that all of healthcare in the US spins out from. A few personal experiences which back this up:
1. I received a $1500 bill because an ambulance that was sent when I called 911 was an "out of network ambulance". I looked it up: One small ambulance company in SF is in-network with that insurer. The SFFD runs the vast majority of ambulances and is "out of network." Insurance companies of course are not allowed to penalize you for accepting the first ambulance that arrives in an emergency. I filed a formal complaint with the California regulator that regulates that insurer and within 2 weeks the bill had been properly taken care of.
2. Our family has met its family Out of Pocket Maximum this year. Twice in the past month I've had doctor's offices lie to me and say that we still have to pay a copay. The last one claimed "well, you still have to meet your individual one though." Lie. That's literally the opposite of the way it works. We've paid copays to these people accidentally in previous years and they would never give the money back, they just keep it and also double dip since insurance pays them anyway.
In all cases, both hospitals and insurance companies simply ask for the maximum possible thing they can ask for, knowing that a frightening majority of people are afraid of them, and will pay whatever they're told. In OP's case, an unsophisticated payer would have gotten a $195k bill, been sent to collections, the hospital would have sold the bad debt, and then the person would have maybe "gotten a good deal" by getting it cut down to $50k over many years of high-interest payments and having ruined credit.
Insurance and hospitals are both filthy, money-grubbing machines. To paraphrase a famous cartoon character, their business is bad and they should feel bad.