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.
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.
I went to hospital and they assured me my procedure was covered by insurance and I wouldn't need to worry about that and in worst case scenario insurance would contact me. Couple of days later this hospital sent me $400 bill. It took me several phone calls to get them to acknowledge that they sent it by mistake.
Exactly same situation happened year later but with ~$800 bill.
Although doctors and medical staff themselves are ok, the US healthcare system as a whole is some incompetent clown mafia.
It’s hard to understand how the basically fraudulent billing practices in US healthcare are viewed as acceptable and nothing gets done to correct things. I know many people who have stories of people being overbilled by not a little but by a multiple of the normal price. Or the hospital bills for things that never happened. That while the patient never got an estimate upfront. There is basically no way to do it “right”.
And even when you discover a problem you are expected to spend countless hours on the phone negotiating between provider and insurance.
I can’t imagine any other industry getting away with such a persistent track record of bad behavior.
The insurance industry in the USA is so screwed. A few years ago I had to go to the emergency room (turns out it was my gall bladder) and afterwards I got separate bills from the hospital, the anesthesiologist, and the mri. It was one hospital but it turns out it was 3 separate companies.
Of course I didn't get the bills right away. No I got them for months afterwards.
I got the main bill, I called up the hospital to pay and they said they would give me a discount for paying all at once. What? it didn't say that anywhere on the bill. So if I had paid it online I would have paid the full amount and not the discounted price which was a couple hundred less?
Another time I got a bill from the hospital and I didn't know what it was for so I called them and they said "ok. We'll resubmit it to your insurance." and I never heard about it again. If I hadn't called I would have paid a bill for over a thousand dollars.
I got one bill for $20 a year after. The address was in another city so I was skeptical. I went to their website and put in the account number and it said I didn't owe anything. Was it a scam? Who knows.
Another time I had an mri scheduled for something else and I get a call from the insurance company asking if I would be willing to reschedule to another hospital 90 minutes away because it was cheaper.
I can't imagine how terrible it would be if I had some serious or long term illness. Imagine if any other industry was this sloppy and confusing in their billing.
* I paid $20 K out of pocket for a surgery that my insurance would not cover.
* A few weeks after surgery, I developed a complication that left me in HORRIFIC pain several hours / day.
* Almost immediately after development of complication, I got ANOTHER $20 K bill from the hospital.
* I read the fine print on my contract, "HOLY SHIT. THEY CAN DO THIS????"
* Meanwhile, horrific pain persists, day after day.
* Wife says, "You need to go to ER."
* Me: "NO WAY. You wanna get hit with ANOTHER $20K bill because I developed a complication due to a procedure that the insurance refused to cover from the get-go? I'll ride this out."
* Horrific pain persists. I cancel a lot of my work.
* A few weeks later, I have a follow-up visit with surgical group.
* I tell surgical group, "I got this $20 K bill ON TOP of the $20K I already paid."
* Surgical group: "Oh. That's a billing error."
* I explain very s-l-o-w-l-y that I did not deal with my horrific pain for WEEKS as a direct result of receiving an erroneous bill and that there may be a lawsuit coming someone's way.
* 15 minutes after leaving my follow-up visit, I got 3 phone calls from hospital admins and surgeon expressing profound regret for the error and assurances that the bill was "gone."
If I could leave the US, I would for this simple reason.
It's an entire industry based on fraud and deception. My wife recently had surgery and we got hit with a $1500 surprise facility fee. It likely won't be covered by insurance due to some fuckery around not reimbursing the fee if the in plan physician owns the facility.
We knew enough to ask about the anesthesiologist and any surgery assistants. But they came up with some new bullshit and got us. When the world gets wise to this nonsense they'll come up with something else. It's a business deeply rooted and based on scamming their customers.
Not true, because people actually hate insurance companies. The best propaganda is by the hospitals because no one ever seems to complain much about them.
There's been a lot of revealing reporting over the past decade but people don't seem to care: the price of a procedure in two different hospitals in the same city can vary by 10x because they literally pull prices they charge from their asses. They tend to justify this by saying "no one ever pays that price".
But when I got a bill for my wife's surgery that included 15k for 1 hour in a recovery room, another 25k for 1 hour in a surgery room, and 9k for an overnight stay (on top of the 20k from the surgeon, 3k from the anesthesiologist, and 3-5k from random doctors we saw for a few seconds) those words sure as shit were not reassuring.
All my past attempts to get an idea of what something might cost me, even when I knew insurance wouldn't cover it, have failed. It takes days worth of time on the phone only to get the wrong answer. One even told me that I only get the cash price if I don't have insurance even if my insurance won't cover it - and I must have insurance because its illegal to not have insurance so I can't get the cash price. What the fuck man?
Hospitals can fuck off. I have no idea why they don't get more blame in this mess.
Horrible, disgusting, yet not at all surprising. I don't know what medical billing accountability looks like in this dizzyingly complex system, but as a US citizen and patient of the US healthcare system, it looks barely existent. My family has fought our fair share of bogus healthcare charges. One instance: after my daughter was born at a birthing center (independent of a hospital), my wife experienced postpartum complications and was transferred to a nearby hospital for care. As if that experience wasn't stressful and traumatic enough, many months later we were hit with a surprise charge from the hospital for treatment and care of our newborn baby - the baby that was delivered hours earlier, in a separate location, that never left my arms in the hospital!
All that to say - it's alarmingly easy for a charge to get processed in a batch of other charges, and either insurance pays it without question, or the patient pays it unknowingly. During our experience, we learned that this kind of thing is exceedingly common. The power dynamic between patients and healthcare administration severely misaligned, the information imbalance is huge, and the patient is always in a compromised position.
The article doesn't include details on how they tracked down these criminals (I'm curious to know!), but it wouldn't surprise me in the least if this is just the tip of the iceberg.
My girlfriend had a surgery two years ago and she is still getting random new bills from providers we don’t even know. Often in the range of several 10000 dollar. It’s really infuriating. She had cleared everything with the insurance but she still has to spend hours and hours trying to clear this up. In my view dealing with the mafia is more transparent and easier to understand than what hospitals do. I have never seen such a clusterfuck in any other industry.
They believe they can charge whatever they want even years after the service. You can never be sure if you are really done with them.
But all these stories are so absurd it's mind-boggling why you all Americans still put up with this BS. It's unthinkable anyone would even try to pull something like this in Europe. When I was going through a surgery in the facility I choose they presented me with a detailed bill (I could do it for free but I preferred to have more comfort with a private room etc.). Moreover, I paid it in full in advance. I was aware the costs might get higher in the case of complications but I roughly knew their cost.
It's really unbelievable anyone would ever agree to pay ridiculously high sums someone else just pulled out of thin air post factum. It's unfair, it's absurd, it's breaking people's lives. Why don't you collectively decide to end it once and for all?
There are three heads to this beast: hospitals, insurance companies, and drug companies. Each swears it is innocent and points to the other two and calls them the problem, but they are all guilty.
You've covered the evil tactics of insurers, but providers absolutely engage in intentional opaqueness, overbilling, and as much screwball behavior as the market will bear. No, the insurance company did not force them to charge $500 for an aspirin and "accidentally" bill in full for a procedure that was discussed as a hypothetical but never actually happened. "Look over there!" isn't going to cut it as an excuse forever.
What always amazes me is that they can get away with constant mistakes, overcharging and unjustified denials without any real consequences. The worst that can happen is that they have to correct the mistake and do what they should have done anyways. And this only after the patient has spent enormous amounts of time, energy and money. I don’t think any other business would get away with this.
My partner has been employed with the same large international company for 8 years. She had an elected procedure done that is required by law to be fully covered by insurance. She had 3 calls leading up to the procedure with her health insurance company each time asking them if they were certain it would be covered 100%. I thought that this was overkill but she was worried to the point of being paranoid about it. They assured her each time she would not have to pay any money at all for anything.
The procedure was in December. After the procedure she received a 6-figure bill, which she then had to follow up with hours of phone calls back and forth to the insurance company, hospital, and doctor's office. They sent her a revised bill for somewhere around $8,000, and then another revised bill for around $4,000.
The insurance company says it's because the doctor coded the procedure incorrectly. The doctor says the hospital coded it incorrectly. She has had to file an appeal with the insurance company, and the only reason it looks like it will work out is because the insurance company records all phone calls and was able to get records of her original calls before the procedure asking if it would be fully covered. She has still been told to expect that they will deny her first appeal and she'll have to appeal a second time in order to get it covered. This has been causing her immense stress for the past 4 months as she does not have enough money to pay even the $4,000 bill out of pocket.
My experience is that your experience actually is extremely uncommon in America today. Most people who have to interact with the health care system beyond annual checkups have to deal with something like this.
To add my own anecdote about US healthcare, I needed a hernia repair surgery in my early 20’s.
My dr referred me to a specialist, I asked if he was in network for my insurance and everything seemed good. But in what I have since come to realize is a quintessential US healthcare experience, it turns out the facility that this independent surgeon used and the anesthesiologist were not in network. Nobody bothered to tell me about this before the surgery, so I went through with it.
Later I see the bill is about $39k, and my insurance has decided they’ll pay $1174. I was freaking out, but I got a call from the billing department and they asked if I could just pay $200, which I did and they called it a day and everything was settled.
It makes just as little sense as any of the horror stories I’ve heard, but somehow worked out pretty reasonably for me. I still have no idea how this happened. Did I get incredibly lucky? Or are more of these horror stories you hear where someone “ended up with a $50k medical bill”, just on paper and those amounts rarely actually need to be paid?
Not just health insurance, but healthcare is crazy too.
Spent a total of 36 hours on the phone with the hospital to figure out how much something would cost because I knew I had to pay out of pocket. And they weren't even right when they finally gave me a number.
Had a doctor remove a cotton ball from my ear in the hallway. Charged me 2.4k for that. Didn't have insurance either.
My wife's friend delivered her own baby in the hallway and they still sent her a bill for delivery.
My wife had her gall bladder removed, supposedly the most common surgery. Surgeon charged 25k, hospital charged 65k, anesthesiologist charged 3k, and a doctor that talked to her for 25 seconds charged 1.5k. Insurance and the hospital argued over the bill for almost a year, during which time the hospital kept sending me payment due notices.
As far as billing goes I view US hospitals basically as criminal organizations. They lie, make up things, hide things and make no effort to do better. Problem is that a lot of people are making a very good living off this insane system and will fight any change tooth and mail.
I had a similar experience for a minor hand surgery. The thing is, when I called the insurance company (or was it the billing dept at the hospital? I don't remember) they went like, "oh, that's wrong" and like magic $5000 in bills disappeared. How many people just pay without asking? How many people don't care because it's the insurance co covering the bill? The whole system just seems rife with inefficiency.
"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.
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.
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