Health Insurance fuckery

[Fastbreak 3959]

Quote

Olympic gymnastics champion Mary Lou Retton is “fighting for her life” in an intensive care unit, according to her daughter.

Retton has been diagnosed with “a very rare form of pneumonia” and has been in the ICU at an undisclosed hospital for more than a week “not able to breathe on her own”, McKenna Kelley said in an Instagram story posted on Tuesday afternoon.

“Out of respect for her and her privacy, I will not disclose all details,” wrote Kelley, a former gymnast at Louisiana State University. “However, I will disclose that she is not insured.”

She added: “We ask that if you could help in any way, that 1) you PRAY! and 2) if you could help us with finances for the hospital bill.”

She should have won more gold medals - am i right?
---

What the fuck is wrong with us that we have these kinds of stories every day?  It's disgusting that health care is some kind of special benefit that now only the ultra rich can really afford.  The health of the nation is basically controlled by few insurance companies and lobbyist.  The system only benefits them AND the fucking rubes go along with it.  Why does everything have to be fucked up when it is so simple to fix?

[tx 3 putt 76403]

Her sport fund me has $250k + 

[MrBig 5289]

23 minutes ago, tx 3 putt said:

Her sport fund me has $250k + 

I’m sure her bill is going to skyrocket from the “self-pay” prices to the “go fund me” prices.

[tx 3 putt 76403]

1 minute ago, MrBig said:

I’m sure her bill is going to skyrocket from the “self-pay” prices to the “go fund me” prices.

 

correct

[Fastbreak 3959]

So the best insurance plan is:

1. Be famous
(Get sick)
2. Start a go fund me

A big problem is everyone thinks they are going to be famous or rich. Almost all of my redneck relatives think they are days away from being a millionaire or a tik-tok sensation.

[Willfully Horn 7916]

This sucks. My wife tells stories about her from their college days. Get well, MLR.

Not having insurance, and insurance not covering her illness, are not the same thing. I wouldn’t put it past bean counter types to decide that breathing on her own, without the help of a machine, is “not medically necessary.” At least, that’s what Blue Cross and Blue Shield wanted to say about paying for cataract surgery: not medically necessary. I had one good eye. How many does it take to see? 
 

Single payer. 

[Bookman 4611]

5 hours ago, Willfully Horn said:

Not having insurance, and insurance not covering her illness, are not the same thing.

Unless the insurance is not covering something they are supposed to be, then they are the same thing.

[Captainant 27467]

6 hours ago, Willfully Horn said:

Not having insurance, and insurance not covering her illness, are not the same thing. I wouldn’t put it past bean counter types to decide that breathing on her own, without the help of a machine, is “not medically necessary.” At least, that’s what Blue Cross and Blue Shield wanted to say about paying for cataract surgery: not medically necessary. I had one good eye. How many does it take to see? 

Your mentioning eyes is it's own frustration - eye and dental care isn't covered in a normal healthcare plan. Because you don't need good vision or teeth right?

When my dad was still alive it was like going to fucking war to get any sort of PT for his Parkinson's. They'd just send us some resistance bands and say "thoughts and prayers!" and do jack shit.

"""Health""" insurance companies exist solely to leech off of medical transactions and skim profits off for their shareholders. They have pushed costs up, given us months long wait times to get medical care, and worst of all, given us anastasis. It's an industry that should not exist and has a fundamentally flawed business model. 

Everyone is gonna get sick and need care. We should not allow profit driven and GREEDY hangers-on to interject themselves into our medical decisions. It's not for our benefit. It's for the benefit of their shareholders. 

[Guest]

Health insurance system sucks horribly, but there's little reason not to have it with Obamacare.

If you have a low income, the plans are cheap. You get dinged when you make a little bit of money to where you don't get subsidies but not enough to where the cost is easy to stomach. Our family of three is paying about $850 a month.

The insurance is shit (high deductibles/out of pocket maximums), but it is coverage.

But yes, the entire system is just atrocious.

[Dbeasy 14970]

The Obamacare system has been very frustrating for me personally. I can't use it, because the doctor networks offered are so poor, I can't count on it to cover critical doctors my wife and I need for some unusual health issues. But, since we both didn't work, we couldn't get any other insurance due to health issues.

So the only alternative was to have one of us go back to work solely for health insurance. It's ridiculous. Twelve years ago, before Obamacare, we could get on a Texas health exchange that was relatively affordable as compared to corporate health plan premiums, covered a wide range of doctors, and required no medical questionnaires. 

Obamacare has been good for a sliver of the population that don't need good care, and don't have to go to the doctor. It's almost worthless for low income people because of the sky high deductibles. My friend offered partial Obamacare coverage to all of his employees and none of them took it, because the deductibles made it not make sense. In their minds, they were better off just rolling the dice and using the money saved from not paying premiums to use towards any costs. And if they had a major expense, just don't pay it.  The whole system is so screwed up.

[pacman 7330]

America, leading the world in health innovation so that non-Americans can live long, healthy lives while Americans suffer.

Who would ever want to live in a society that can cure but elects not to because of money?

[Al Bundy's Napoleon Hand 13547]

The deductible in my non-Obamacare plan thru my employer is 4000 bucks.

[miguelito 11220]

59 minutes ago, Captainant said:

and worst of all, given us anastasis.

Those motherfuckers!

 

Wait, are you talking about the Surly poster?

[Red Five 40666]

What does Shannon Kelley do for a living?

[Fastbreak 3959]

I also love the "my employer pays my insurance" angle.  When i had my own company we were paying on average $900 a month per employee and then they would pay around $450 or so (this is 10 years ago, video games with average employee age <30).  So that is $1350 a month that somehow is a "benefit" without anyone thinking that it would be much nicer to have the cash in pocket each month and not have to worry about paying off some corporation whose sole goal is to make money on your health and to fuck you without lube whenever possible.

[CooterBrown 17913]

9 hours ago, MrBig said:

I’m sure her bill is going to skyrocket from the “self-pay” prices to the “go fund me” prices.

It won't cover it.  When I got stents in 2014, I was in the hospital for 5 days. The bill was $210,000.  That'd probably be $350,000+ in today's dollars and inflated costs.

[Hawndoh 2382]

The whole industry makes no sense.

My wife has a prescription for migraines. It has always been free under our insurance.

One day she goes to get a refill and they say "that will be 400 dollars"

Long story short, they had tried to fill it for 20 pills when it had always been 19 pills. 19 pills is free, but 20 pills is 400 bucks.

[Hornius Emeritus 12420]

2 hours ago, Red Five said:

What does Shannon Kelley do for a living?

He works in the athletic department of Houston Baptist University, I think. But he and Mary Lou are divorced.

[Francisco 2.0 32342]

2 hours ago, CooterBrown said:

It won't cover it.  When I got stents in 2014, I was in the hospital for 5 days. The bill was $210,000.  That'd probably be $350,000+ in today's dollars and inflated costs.

 

My 2 hour outpatient right shoulder surgery (torn labrum, rotator cuff, etc) was $55,000 in early 2020.  And I didn't even get a fucking meal out of the hospital.

 

 

[conVINCEd 21468]

I had to go to the ER in  2020.  Was there for most of the day.  Lots of tests.  Sent home late that evening.  No procedures.  $35k.

[Red Five 40666]

15 minutes ago, Hornius Emeritus said:

He works in the athletic department of Houston Baptist University, I think. But he and Mary Lou are divorced.

Huh, didn't know that. 

[Nice Guy Eddie 13414]

Retton’s story is a prime example of why you have to have some health insurance even with ridiculous deductibles and limited benefits. If you don’t have insurance, you’re rolling the dice that you won’t be hospitalized. If you lose, it can wreck the finances of you and others.

our system has many flaws but that doesnt absolve someone from being responsible based on the current rules. 

[MonkeyDoughnut 10145]

My health industry sucks story was from 20+ years ago when one of my kids was born and hospital bill had an item on it for $1,000 or such for extra night in hospital. I questioned them and they said insurance wouldn't cover it to which I explained I was told they might not, but was also told it would be $300 if they didn't. They straight faced said - that's the cash pay rate, because you have insurance it's $1000 and since they won't pay you owe $1000 because you are on the "insured" rate plan.

['stache 21777]

My wife was on bedrest for a month and my son was in the NICU for 2 months. They processed my insurance wrong and I got a bill for $1.1 million. I'll never for the life of me understand how a bunch of poor bastards are okay with this because the same party is suppressing made up trans threats or whatever. 

[Nice Guy Eddie 13414]

1 minute ago, MonkeyDoughnut said:

My health industry sucks story was from 20+ years ago when one of my kids was born and hospital bill had an item on it for $1,000 or such for extra night in hospital. I questioned them and they said insurance wouldn't cover it to which I explained I was told they might not, but was also told it would be $300 if they didn't. They straight faced said - that's the cash pay rate, because you have insurance it's $1000 and since they won't pay you owe $1000 because you are on the "insured" rate plan.

I know you can’t easily shop hospitals like other products in the world, but you sometimes have to research, push back, and ask for alternatives. Especially with medication. My mom had some new medicine that would cost between 50-75 per month with using her insured rate. Not back breaking but more than she used to pay. I found that HEB would charge $6 per month cash price. Sold. See ya CVS.

I even find that pharmacists will help you identify alternatives or different dosages that significantly lower costs. Take that info to the doc to get their thoughts.

Ive been in line behind people that chew out the pharmacy tech who has no control over the costs. Treat them with respect and you might find they can help you. Work with the system not against it.

[Brisketexan 104628]

15 minutes ago, Nice Guy Eddie said:

Retton’s story is a prime example of why you have to have some health insurance even with ridiculous deductibles and limited benefits. If you don’t have insurance, you’re rolling the dice that you won’t be hospitalized. If you lose, it can wreck the finances of you and others.

our system has many flaws but that doesnt absolve someone from being responsible based on the current rules. 

Yep.  And ZERO defense of the current approach, by the way.  But when I turned 25, I went off my parents' insurance.  Wasn't going to start a job that offered insurance for like 5 more months.  Texas Exes offered a bare-bones health insurance plan that I just called my "if I get hit by a bus" insurance.

Didn't pay for shit in terms of basic Dr. visits.  High deductible.  BUT, if I got hit by a bus, or diagnosed with a serious illness, etc., I wouldn't get stuck with a $1 million bill.  It was cheap, but that was also over 25 years ago.  Maybe $100 a month?  Also, I was 25, so pretty low risk of getting seriously ill.

Having "hit by a bus" basic insurance really is important to do if you can pull it off at all.  Looks like Texas Exes still offers a similar plan, but it's just a short-term thing: https://www.texasexes.org/membership/member-benefits/short-term-medical-insurance

 

[C-Man 27058]

4 hours ago, Captainant said:

Your mentioning eyes is it's own frustration - eye and dental care isn't covered in a normal healthcare plan. Because you don't need good vision or teeth right?

When my dad was still alive it was like going to fucking war to get any sort of PT for his Parkinson's. They'd just send us some resistance bands and say "thoughts and prayers!" and do jack shit.

"""Health""" insurance companies exist solely to leech off of medical transactions and skim profits off for their shareholders. They have pushed costs up, given us months long wait times to get medical care, and worst of all, given us anastasis. It's an industry that should not exist and has a fundamentally flawed business model. 

Everyone is gonna get sick and need care. We should not allow profit driven and GREEDY hangers-on to interject themselves into our medical decisions. It's not for our benefit. It's for the benefit of their shareholders. 

Actually, things having to do with your eyes can -- and does -- fall under your normal health care plan. Routine eye exams, contacts and eyeglass prescriptions is "Vision" but most anything beyond that falls under medical plan.

The medical insurance program in this country is bat shit insane. Carriers slow-pay or simply don't pay doctors so the doctors have increased their costs to make up the difference. It's grift from all sides unfortunately and we carry the burden as a populace. The rest of the world has this so much better figured out than us. I know this won't be fixed in my lifetime.

 

22 minutes ago, Nice Guy Eddie said:

Retton’s story is a prime example of why you have to have some health insurance even with ridiculous deductibles and limited benefits. If you don’t have insurance, you’re rolling the dice that you won’t be hospitalized. If you lose, it can wreck the finances of you and others.

our system has many flaws but that doesnt absolve someone from being responsible based on the current rules. 

As many of you know, I'm in the insurance world (property and casualty) but have my life/health license. Unfortunately, we're getting to a state where insurance is only going to be good for catastrophic type situations (house burns down, gets washed away by a flood/hurricane, etc) in my world. Same in the health world. Yeah, it's frustrating that my PCP decides to double-code my annual physical so he can "earn" a well visit in addition to billing insurance for my "free" physical (I'm shopping PCP's, BTW) but that's a pittance in the grand scheme of things if I get diagnosed with cancer or am injured in a major auto accident and my care is in the millions. It's inconceivable that Retton doesn't have some form of catastrophic, high deductible health insurance at an absolute minimum.

[C-Man 27058]

10 minutes ago, Brisketexan said:

Yep.  And ZERO defense of the current approach, by the way.  But when I turned 25, I went off my parents' insurance.  Wasn't going to start a job that offered insurance for like 5 more months.  Texas Exes offered a bare-bones health insurance plan that I just called my "if I get hit by a bus" insurance.

Didn't pay for shit in terms of basic Dr. visits.  High deductible.  BUT, if I got hit by a bus, or diagnosed with a serious illness, etc., I wouldn't get stuck with a $1 million bill.  It was cheap, but that was also over 25 years ago.  Maybe $100 a month?  Also, I was 25, so pretty low risk of getting seriously ill.

Having "hit by a bus" basic insurance really is important to do if you can pull it off at all.  Looks like Texas Exes still offers a similar plan, but it's just a short-term thing: https://www.texasexes.org/membership/member-benefits/short-term-medical-insurance

 

Well said.

[Dnaguy 11777]

So you're telling me that eating your Wheaties ISN'T insurance in and of itself?

[MonkeyDoughnut 10145]

31 minutes ago, Nice Guy Eddie said:

I know you can’t easily shop hospitals like other products in the world, but you sometimes have to research, push back, and ask for alternatives. Especially with medication. My mom had some new medicine that would cost between 50-75 per month with using her insured rate. Not back breaking but more than she used to pay. I found that HEB would charge $6 per month cash price. Sold. See ya CVS.

I even find that pharmacists will help you identify alternatives or different dosages that significantly lower costs. Take that info to the doc to get their thoughts.

Ive been in line behind people that chew out the pharmacy tech who has no control over the costs. Treat them with respect and you might find they can help you. Work with the system not against it.

Agreed, next time anyone goes to pick up prescription, ask what the cash price would have been. On many prescriptions my copay is above the cash price.

[Viking 299]

During my 2 year sabbatical I had the bottom tier Obamacare plan but only considered it catastrophic insurance. Useless for anything under 15k (or whatever the deductible was).

The subsidy was another FU to poor people. No subsidy if you made less than ~40k.

[Nice Guy Eddie 13414]

It's tragic, from an economic efficiency POV, when someone opts out of insurance or even a visit to the doctor to save <$500. Then they end up in the ICU for $10,000+ per day. Then we get the Go Fund Me asking others to help out with that 5 or 6 figure bill.

Some people can avoid hospital visits by taking care of the initial illness for less than $50. For an upper respiratory ailment, you can see a nurse practitioner via a smart phone for $25 and the prescription could be as low as $5. Now Retton has something her daughter described as a rare pneumonia, so maybe it does require a lengthy hospital stay and can't be avoided. I don't know.

Disclaimer: I'm not blaming sick people. I'm blaming that we have a bad system and we don't educate people how best to navigate it.

[Nice Guy Eddie 13414]

4 minutes ago, MonkeyDoughnut said:

Agreed, next time anyone goes to pick up prescription, ask what the cash price would have been. On many prescriptions my copay is above the cash price.

GoodRx should be everyone's friend if they have frequent prescriptions. The app tells you the non-insurance rate at nearby pharmacies. Now it doesn't count against any insurance deductible but that may not matter.

Also push back on doctors is they prescribe an expensive option. Do you need a Ferrari medication if a Yugo will do.

[CooterBrown 17913]

58 minutes ago, Nice Guy Eddie said:

Retton’s story is a prime example of why you have to have some health insurance even with ridiculous deductibles and limited benefits. If you don’t have insurance, you’re rolling the dice that you won’t be hospitalized. If you lose, it can wreck the finances of you and others.

our system has many flaws but that doesnt absolve someone from being responsible based on the current rules. 

It doesn't matter if you have insurance.  When I got stents and the $210,000 bill, UnitedHealthCare denied the claim based on the idea that I should've never been admitted to the hospital for undetermined chest pain, so the blockage should've never been discovered.  It didn't matter that my PCP sent me over to see a cardiologist immediately and he told me to go get admitted ASAP.  

The only luck in the whole situation was that I went to Seton and UHC's contract with Seton stated that the hospital had to eat the cost of denied claims beyond my copays.

One night in the hospital, the overnight doctor that came in to look at my chart and was there for 1 minute charged me $1,700. He was out of network so I had to pay that out of pocket as if I had a choice to see him.

 

 

 

[MonkeyDoughnut 10145]

13 minutes ago, CooterBrown said:

It doesn't matter if you have insurance.  When I got stents and the $210,000 bill, UnitedHealthCare denied the claim based on the idea that I should've never been admitted to the hospital for undetermined chest pain, so the blockage should've never been discovered.  It didn't matter that my PCP sent me over to see a cardiologist immediately and he told me to go get admitted ASAP.  

The only luck in the whole situation was that I went to Seton and UHC's contract with Seton stated that the hospital had to eat the cost of denied claims beyond my copays.

One night in the hospital, the overnight doctor that came in to look at my chart and was there for 1 minute charged me $1,700. He was out of network so I had to pay that out of pocket as if I had a choice to see him.

 

 

 

The whole in-network / out of network is bullshit. Why is that responsibility on the patient when most times they did everything they could to stay in network.

[Nice Guy Eddie 13414]

26 minutes ago, CooterBrown said:

It doesn't matter if you have insurance.  When I got stents and the $210,000 bill, UnitedHealthCare denied the claim based on the idea that I should've never been admitted to the hospital for undetermined chest pain, so the blockage should've never been discovered.  It didn't matter that my PCP sent me over to see a cardiologist immediately and he told me to go get admitted ASAP.  

The only luck in the whole situation was that I went to Seton and UHC's contract with Seton stated that the hospital had to eat the cost of denied claims beyond my copays.

One night in the hospital, the overnight doctor that came in to look at my chart and was there for 1 minute charged me $1,700. He was out of network so I had to pay that out of pocket as if I had a choice to see him.

It did matter for you that you had insurance. You wrote that UHC kept you from paying $210K because of UHC's contract with Seton. That's was a worthwhile benefit for you.

And the stories of people receiving $200K or $1M dollar bills are crazy to see, but it's common to see that much of the bill is commonly eliminated later on. It's why I'm also skeptical when someone is asking for funds in a Go Fund Me while they're still in the hospital. There is time to see what the bill will ultimately be resolved to.

Edited October 12, 2023 by Nice Guy Eddie

[Nice Guy Eddie 13414]

14 minutes ago, MonkeyDoughnut said:

The whole in-network / out of network is bullshit. Why is that responsibility on the patient when most times they did everything they could to stay in network.

While this situation could occur, there are new controls to prevent surprise billing to the patient who did everything they could.

It doesn't mean that you won't receive a large bill but a bill does not equate to the money leaving your bank account. Call and ask questions. Worse case, you can appeal to a state board about it.

[Neonmoon 38127]

If only there was a system where everyone could get medical care...

Oh well, guess it's just one of those unsolvable mysteries like gun violence. 

 

[Biff Tannen 45499]

6 hours ago, Captainant said:

They have pushed costs up, given us months long wait times to get medical care, and worst of all, given us anastasis

Wait wut?

[texasdago 7553]

Our system sucks so badly.  

[Nice Guy Eddie 13414]

13 minutes ago, texasdago said:

Our system sucks so badly.  

All healthcare systems suck to some extent. There will always be limits in resources that either slow down care for some or all. It's prohibitively expensive to have services on demand for everyone.

Personally I think we should expand the ACA will full subsidies for more people. Keep the capitalistic system but let the govt pay for the poor(er) people.

[DigglerontheHoof 21065]

1 hour ago, Neonmoon said:

If only there was a system where everyone could get medical care...

Oh well, guess it's just one of those unsolvable mysteries like gun violence. 

 

I work for a Canadian company.  The U.S. employees have Aetna and the Canadians, obviously, have their single-payer HC.   

I have a colleague who has a kid with chronic HC issues and he HATES the Canadian system and envies the U.S. employees getting the ability to have private insurance.  Crazy shit. 

I've heard several nightmare scenarios from a handful of Canadian folks over the years.  No system is perfect. 

[LCHorn 2585]

Ah, this topic again.  If you say @Bozo_Casanova three times he’ll jump in here and start shouting “Wyden-Bennett you motherfuckers!” at the rest of us.  

[Bozo_Casanova 26284]

WYDEN-BENNETT YOU MOTHERFUCKERS!

[Neonmoon 38127]

24 minutes ago, DigglerontheHoof said:

I work for a Canadian company.  The U.S. employees have Aetna and the Canadians, obviously, have their single-payer HC.   

I have a colleague who has a kid with chronic HC issues and he HATES the Canadian system and envies the U.S. employees getting the ability to have private insurance.  Crazy shit. 

I've heard several nightmare scenarios from a handful of Canadian folks over the years.  No system is perfect. 

No shit? Well I know these 3 million Americans and they owe over 10,000 in medical debt they can’t afford. I also heard that Humira was 427% more expensive in the US than the UK. 

It sucks about your colleagues kid, but they can buy private insurance if they are not satisfied with the single payer 

[Huckleberry 32704]

2 hours ago, Nice Guy Eddie said:

It doesn't mean that you won't receive a large bill but a bill does not equate to the money leaving your bank account. Call and ask questions. Worse case, you can appeal to a state board about it.

The first sentence is key. And the last sentence is unfortunately the last resort for many people, but for me a few times I've simply never paid. I have always and always will pay debts that I agreed to. 

But if you think I'm paying you $1700 for one minute of attention without telling me how much it would be you can fuck right off. You will never see that money. Same with an ambulance bill once. The EMTs administered smelling salts and drove my daughter 4 miles. $2500. Haha fuck you. Nope. On that one I researched rates for the same service in the area and got two numbers at $1500 and $1600. Absurd in their own right but I called and said I'd pay $1600 to settle. They said they don't negotiate. I said cool, you'll get nothing. 

I realize there are reasons not everyone can do that. But a lot more people can than realize it. Too many people consider themselves prisoner to whatever number the provider pulls out of the air. 

[Huckleberry 32704]

I have insurance and always have. There was some standard insurance fuckery, but in this case I actually understood BCBS's position that the rate was too far above reasonable market cost or whatever. So they went after me. They were just as successful as they were getting BCBS to pay any more than they did. 

Edited October 12, 2023 by Huckleberry

[Nice Guy Eddie 13414]

33 minutes ago, Huckleberry said:

The first sentence is key. And the last sentence is unfortunately the last resort for many people, but for me a few times I've simply never paid. I have always and always will pay debts that I agreed to. 

But if you think I'm paying you $1700 for one minute of attention without telling me how much it would be you can fuck right off. You will never see that money. Same with an ambulance bill once. The EMTs administered smelling salts and drove my daughter 4 miles. $2500. Haha fuck you. Nope. On that one I researched rates for the same service in the area and got two numbers at $1500 and $1600. Absurd in their own right but I called and said I'd pay $1600 to settle. They said they don't negotiate. I said cool, you'll get nothing. 

I realize there are reasons not everyone can do that. But a lot more people can than realize it. Too many people consider themselves prisoner to whatever number the provider pulls out of the air. 

BCBS does not have negotiated rates with your city's EMS services in Texas? That's weird. Or did you call a private EMT?  The distance doesn't matter or the rate per mile is relatively small. 

 

[locodos 5334]

57 minutes ago, Huckleberry said:

The first sentence is key. And the last sentence is unfortunately the last resort for many people, but for me a few times I've simply never paid. I have always and always will pay debts that I agreed to. 

But if you think I'm paying you $1700 for one minute of attention without telling me how much it would be you can fuck right off. You will never see that money. Same with an ambulance bill once. The EMTs administered smelling salts and drove my daughter 4 miles. $2500. Haha fuck you. Nope. On that one I researched rates for the same service in the area and got two numbers at $1500 and $1600. Absurd in their own right but I called and said I'd pay $1600 to settle. They said they don't negotiate. I said cool, you'll get nothing. 

I realize there are reasons not everyone can do that. But a lot more people can than realize it. Too many people consider themselves prisoner to whatever number the provider pulls out of the air. 

 

49 minutes ago, Huckleberry said:

I have insurance and always have. There was some standard insurance fuckery, but in this case I actually understood BCBS's position that the rate was too far above reasonable market cost or whatever. So they went after me. They were just as successful as they were getting BCBS to pay any more than they did. 

I had this happen to me.

Call BCBS and tell them what's happening, they'll say the rate is too high and they only cover X, ambulance company will say they don't have a contract so tough.  Make them work it out.

In my case, the ambulance was called by the hospital to transport my son to a different hospital. (I did not call or make the arrangements)  The ambulance was from the city fire dept.   When the bill came it was $1000+ and I was already dealing with UHC as there were a lot of other bills.  UHC said they would only pay $350 of the $1000 and the 3rd party billing company for the fire department (an outfit out of Arizona) basically stone walled me.   I went back to UHC, told them it was an emergency (as determined by their preferred hospital) and they needed to cover it and that it wasn't my problem that their hospital called an ambulance that they didn't have a contract with and they needed to negotiate it now, not me.   And I think that was a very defensible position to take.

long story short...  they got it down to $350-ish and I payed it.  Six months later I got a check from the city for the cost of the ambulance ride.  Unexpected, but I was wondering why may taxes get to pay for a robust fire department that they were billing me to use!

 

TL/DR US healthcare is massively broken in concept and practice.  At some point in time you will face this system and it will piss you off.

Edited October 12, 2023 by locodos

[Anastasis 23394]

41 minutes ago, Huckleberry said:

The first sentence is key. And the last sentence is unfortunately the last resort for many people, but for me a few times I've simply never paid. I have always and always will pay debts that I agreed to. 

But if you think I'm paying you $1700 for one minute of attention without telling me how much it would be you can fuck right off. You will never see that money. Same with an ambulance bill once. The EMTs administered smelling salts and drove my daughter 4 miles. $2500. Haha fuck you. Nope. On that one I researched rates for the same service in the area and got two numbers at $1500 and $1600. Absurd in their own right but I called and said I'd pay $1600 to settle. They said they don't negotiate. I said cool, you'll get nothing. 

I realize there are reasons not everyone can do that. But a lot more people can than realize it. Too many people consider themselves prisoner to whatever number the provider pulls out of the air. 

Absolutely negotiate, esp when it involves an inpatient admission and in most cases when it involves an ER encounter or certain outpatient services. Wife was admitted back in Jan. We got initial bills totally ~$90k.  Lots of stupid in there. We were on the hook for I think like $6k (on a HDHP). Told her to file away any bills that come in for the next couple months and don't send them shit until the adjudication process work out. Haven't done the math on the final out of pocket, but it is somewhere under $2500. Fucking ERs are a racket with their in/out of network provider bullshit. I've had ED docs look at me like I have three heads when I asked them to confirm that their provider group was in-network before rendering services. I've also had to bend over and enjoy it when your fn 2 year old needs a lumbar puncture and you have no other realistic emergent option, so you have to negotiate the fees on the back end. If you have a reasonable basis for pushing back on the charges, they will settle for dimes on the dollar. I settled probably a couple thousand in bills for cardiac monitoring device for my son at the beginning of COVID. Figured they needed the money and would make a deal so we made them an offer that I thought was more than reasonable considering the device never transmitted and required a professional interpretation of the data. They accepted and closed the account.

 

What we need is a system that requires pricing transparency, incentivize price competition, and backstops against catastrophic events. There are relatively straightforward ways to get there, at least conceptually. Too many interests vested in the current system though.