Nearly 100% of people spend some time in a hospital in their lives.
Unless you're claiming that hospitals only gouge some tiny subset of people and are benevolently generous to everyone else, that number is going to be much closer to 100% than 0.1%.
When I lived in the US, I have personally experienced this, even with top-tier insurance--from both ends: I've had insurance decline claims arbitrarily and pass on five-figure costs to me, and I've had hospitals misclaim things. In both cases, I had to spend dozens of hours on the phone to resolve it.
Most people in the US are far less privileged: Their insurance is not as good, and they don't have the luxury of spending dozens of hours on the phone.
It's just a matter of time until you experience this.
It's more like 80% of the population, when considering expenses not covered by insurance. A hospital can charge you for anything and you're legally obligated to pay it.
The typical billing experience for anything non-trivial in US hospitals is batshit crazy.
One visit can generate three or four bills from different people and institutions. Some of these bills they'll tell you to ignore if you call about them because insurance is covering all or part of it, but they sent the bill before that was sorted out, for god knows what reason. Don't worry, you'll get more, corrected (hopefully? maybe?) bills later. Then explanation of benefits letters arrive, which look sort of like bills but aren't. Almost certainly, at least one of the billing people and/or the insurance folks screwed something up and you'll get to spend most of a day on hold with insurance and a hospital or test processing company or whatever sorting it out. If you miss anything in this mountain of mostly-useless paperwork you may find late notices in your mailbox a month or two later.
Now you get to try to figure out whether the charges on those late notices were legit, or whether they're the result of some seemingly-alway-incompetent hospital billing department's error. While racing against the date on which it goes to collections, and while fees and such accrue.
By four months out you finally, maybe, know what your total costs were/are, after hours of dealing with it and filling half a filing cabinet drawer with documents.
Now, consider that most procedures will include several visits generating a similar number of bills in the months leading up to it. You'll being bombarded with this garbage non-stop for months on either side of the Main Event. You'll also have some follow up appointments and/or tests. Fun!
Basically everyone involved either doesn't care about doing their job correctly or is actively trying to steal your money. Half the time they don't know WTF is going on. You or your loved ones get to deal with that while you're sick or recovering. We call this health care. Some people prefer to pay a premium for this "service" instead of having single-payer or a national healthcare service because... that would make us less free?
That's how bad it is with insurance. Without is, I'm sure, much worse, though probably less complicated.
I understand your frustration, and I think the US insurance system in general and your case specifically is materially worse than what OP described. After all, you never really got your issue resolved, as you had to pay out of pocket for something that your insurance was probably supposed to cover. It sucks we don't have anyone obvious to go to with these healthcare issues.
It's never a 15 minute phone call.
Why do people keep telling me this? I'm only going by what OP said. Tell them they were lying when they said they were on the phone for a quarter hour :)
I don’t understand how hospitals and insurance are constantly getting away with this nonsense. Even if people are against socialized medicine and free markets, they should at least make sure that there actually is real market where all participants have the necessary information. And hospitals should be forced to follow rules like sending itemized and accurate bills on time. When I worked in the office I often overheard people being on the phone daily for hours to deal with hospital or insurance. They can basically ignore callers without any repercussions.
I don’t understand how this abuse can be accepted.
I feel sorry that you believe your experience is worth diminishing the experiences of others. I have my mother's bills to prove it. She had a bleeder causing damage the size of a golf ball. No operation performed. A week in the ICU, 2 admitted, and 6 in admitted rehab.
And I had a powered vehicle collision that cost ~$83k without any surgery. The care was so bad (waiting 4 hours for stitches) and when they wanted to admit me, I said to myself "fuck it, I want to get some real sleep at home where I won't be woken every 45 minutes just so they can pad the bill even more as an expensive hotel." I got up and walked out. Minus CT and MRI, I could've done what they did in 3 hours what took them 18. 3 broken bones (T-8, nose, and shoulder) and they kept pushing me to take opiates. The pain was tolerable because it was a high-energy impact with clean breaks.
Also, around 2016, I spoke with a young lady in coffee shop in Redding CA who had a nasal infusion pump with a small tube taped to her face. She was preparing her documentation to attend a bankruptcy hearing across the street. She had stage IV terminal cancer and the doctors and hospitals were trying to take everything she owned while she was alive. 62% of all bankruptcies are due to medical bills and 78% had some form of insurance that obvious didn't help them.
I suggest you might want to get out more and talk to people. The US healthcare system is a fucking racket. People with the privilege of good health insurance rarely get outside of their bubble because "they got theirs" and assume everyone else has the same opportunities and protections. That's not the reality.
"I’ve had to go back and forth on the phone in a Kafka-hell to get my insurance to cover a covered visit because of some opaque clerical error"
the same happened to my ex. Something had gone wrong between hospital and insurance and both refused to fix it. Which left her in between trying to figure this out while trying to recover. It's really infuriating that they can treat people that way. Once you experience this together with billing for things that never happened and insurance refusing things they have to cover, you can only conclude that insurances and hospitals are basically fraudsters that for some reason are allowed to get away with it.
So true! When my girlfriend had surgery a few years there were several occasions where the hospital sent a bill for things that never had happened. She called and every time they basically said "Oops. We'll take it off". And at least once they sent the same claim again a while later.
It's hard to imagine any other industry getting away with that behavior.
Another thing is the insane markups. The surgery my girlfriend was getting was about implanting a device my company is producing. I asked around in my company and after a while got told that our device costs usually around 30000. Looking at the bill the hospital charged 80000 and the insurance paid it.
American hospitals and health insurance are a ripoff and fraud on a gigantic scale and it's shocking that they are getting away with it. The whole system is so corrupt I don't think it can be salvaged.
Hospital bills in the US are a scam, they give huge discounts to insurance companies, expecting to make a profit on any remaining amount, then insurance companies charge patients only a part of that while covering the rest.
That's actually not really true - at least not the "many" part of it. For most hospitals (including critical access hospitals), the default rate on medical bills is nonzero, but nowhere near the amount of money they lose on Medicare patients. The difference is a few orders of magnitude.
Last time my wife went to a hospital in California, they delayed care by like half an hour over insurance and then didn't use it, so she got to spend a few days on the phone half a year later when each doctor who managed to visit the room for a few seconds sent us separate bills at the uninsured rate.
To me hospitals are basically scam operations. My girlfriend has had several surgeries in the last two years. In addition to already outrageous standard prices ($40000 surgical center cost for a surgery where we spent in total five hours at the center) pretty much every bill had mistakes. Then after a few months a collection agency will try to collect for something that never got billed and never has happened. I can accept a mistake from time to time but this seems to be pervasive.
Those calls were theft. That drain was because you were being robbed. Or it would be like other industries, say like a Laundromat, where a call from them could just as well be because of you leaving something behind or a $10 issue, which is organic and real, instead of "a $10 issue" on a script because it causes guilt in 97% of people on the phone. That call you want, the hospital's call you don't. Literally no matter how rich you are, not even a billionaire, can go to a hospital and not be coerced to sign blank checks. Nobody. And you get treated like shit nonstop. American hospitals have terrible hospitality, treat everybody like shit.
To be clear, I'm not suggesting the facilities are getting ripped off. In reddit terms, Everyone Sucks Here. Facilities use every shady tactic to get people in the door, so nobody should shed a tear for them.
My overall answer is that companies that bill insurance live in a complex world. Insurance tries to dodge payouts and will pay the insured; the facilities try to jam billing.
Perhaps an anecdote will be representative: I worked for one of the biggest providers, with dozens of facilities. They had a call center whose job it was to get insurance to approve another 3 days of treatment (30 day stay = 10 of these calls). Insurance companies don't staff their end, so the call centers were paying people to wait on the line for several hours, just to get treatment approved. (I ended up building a Twilio integration to queue up without a person on the phone.)
This is just a shitty, awful area of medicine and business and insurance.
> Try being hospitalized without insurance. You'll find out really fast
Actually no, you still won't. Because the hospitals send out fraudulently inflated/overitemized bills to help their negotiating positions.
To know how much medical care actually costs, you need to have "insurance" and read through the itemized bills and explanations of benefits. The top line large number is the fraudulent amount that has no basis in reality, there is an "adjustment" based on the rates the "insurance" company has actually agreed to pay, there is the amount the "insurance" company pays them, and then there is your portion. Adding the last two, or taking the first minus the second, is as close to knowing how much something costs as you can get in this fucked up system.
Also it bears repeating, never pay a medical bill unless you're damn sure you're responsible for the amount [0]. Even if you have "insurance", often you'll get sent the fraudulent bill right away, and it will take a month or two for "insurance" to bother doing their job. Also billing departments have no problem blatantly lying to you about your (non) responsibility for the fraudulent bill, since it might get them more money.
[0] Of course some times they have you over a barrel like ongoing care getting denied if you have an unpaid balance. In which case you just have to eat it and then hassle your "insurance" company for half a year to get your money back.
You claim a 90% reduction is possible, then your example is a 99% reduction?
You're wrong either way. I've seen some bills my insurer pays around 2% of what is billed, but not most things. Hospitals will ofter sue, and they are aggressive about judgements. If you can pay something, they will take more.
I've been in the hospital without insurance. They bill you for gratuitous stuff regardless of whether you have insurance. They don't mention that there will be a bill when they ask if you want your newborn's hearing checked or if you want to try the experimental sap-based wound sealer they happen to have (both things that actually happened). They seem kind and polite. Then they bill you. One doctor looks over another's shoulder for five minutes. They each bill you.
This is in the US, mind you. In fact, both stays were in Nashville, TN, in the early 2000s.
Someone I know was recently in the hospital for heart surgery. Granted, it’s more involved than a “simple” ER visit, but the total time for the operation was ~7 hours with 4 days of in-hospital recovery after. Total cost: $260k
If you look at the per-hour breakdown it’s insane, even when you consider doctors making $500k+/yr . Consider also the actual hours in contact with a surgeon or doctor vs most of the time that was spent laying in their bed.
I also wanted to note that in every instance I’ve seen where the possibility of insurance is involved, medical care providers will give you a no-questions-asked “cash discount” of 30-40% (typically) just because you’re not the insurance. I basically read this as “we charge them more because we can”.
Unless you're claiming that hospitals only gouge some tiny subset of people and are benevolently generous to everyone else, that number is going to be much closer to 100% than 0.1%.
When I lived in the US, I have personally experienced this, even with top-tier insurance--from both ends: I've had insurance decline claims arbitrarily and pass on five-figure costs to me, and I've had hospitals misclaim things. In both cases, I had to spend dozens of hours on the phone to resolve it.
Most people in the US are far less privileged: Their insurance is not as good, and they don't have the luxury of spending dozens of hours on the phone.
It's just a matter of time until you experience this.
reply