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Comment by OscarCunningham | Hacker News Reader

The "prices" are moves in a game played between hospitals and insurance providers, and don't correspond to anything real or to the amount that gets paid. If a hospital discovers that the patient doesn't have insurance they'll be charged the real (more reasonable) prices instead.

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Millions of americans pay those sticker prices. Just because millions more don't or get discounts doesn't change the fact that those are very real prices.

Yes. The system is bad.

> and don't correspond to anything real or to the amount that gets paid.

Aren't designed to correspond to real payments. But like a sumo wrestling match in a kindergarten, sometimes the little guy gets squashed by accident. And you wind up with people getting $20k bills that don't necessarily know how to get out from under them.

It's

That used to be the case, but in the last two years I have gotten $1k+ bills after insurance that are very real. For relatively common visits to in-network providers.

That's not true at all. I currently have a ~$450 bill for a test where I breathed in a tube for 10 seconds at a constant rate. That's after my insurance paid 4k for it already.

That used to be the case, but what I've experienced lately is the doctors will submit overpriced bill to insurance, insurance says, "oh you haven't hit your annual deductible yet," and passes the massively overpriced bill directly to me, no negotiation, no nothing.

I've gotten so I just ask what the out of pocket cost is to pay cheaper (usually 1/2 price), and they still manage to hose me with extra services.

It's a racket.

you have a HDHP?

I keep it around $2000 to $3000, so it's not high for me. We go to the doctor about once or twice a year for random stuff, so it doesn't make financial sense to have a zero to low deductible.

I want to protect from the hospital bills from something major though, like a car wreck. I'm not sure that those $50 copay per doctor visit right from the start are even available anymore. That's the insurance I had when I was a youngster.

if you have the legally-defined type of HDHP that could explain your bills because in HDHP-world you pay everything up-front until you reach your out-of-pocket yearly deductible (hopefully offset by using the HSA's tax savings; my job offers matching on HSA contributions that offset the premium cost entirely)

I pay (a lot) extra for a traditional PPO and get the old-fashioned $20/$50/$75 deductible.

If purchasing insurance through the Exchanges my experience was that this is not really clear unless you're paying attention to the exact phrasing in 1-2 places.

"If a hospital discovers that the patient doesn't have insurance they'll be charged the real (more reasonable) prices instead."

Totally not true. Often they'll send a collection agency.

It's not "if the hospital discovers", it's if the patient is uninsured and makes it clear to the billing department that they're hopelessly broke, then the hospital gets flexible with the charges or even writes them off. Many billing departments have flexibility and expect to write off a fair number of bills rather than send them to collections, but they're hardly pushing discounted bills or automatically giving discounts.

If you get lucky you get that. Hospital around where I was (Indiana) rarely did such things. My uncle owed over 250k for emergency heart surgery. That was the discounted price, "as low as they could go".

Dude only made around 30k per year... doing flooring, which could now kill him. Even if he could go back to his work, he had been off work for a couple months. The hospital's "reasonable payments" exceeded his income with work, and was impossible out. More common was a collection agency and eventual court date.

What may work (if he has credit and can cover the lowered amount) is "I can borrow enough to cover the Medicare rate for this and pay it now if that will cover it in full. If that won't cover it then I'm not going to borrow from friends and family when I'll still be paying you and never be able to pay them back."

In his case, that wasn't as likely. Construction work, including flooring, often has slumps and that makes loans more difficult to get. Not to mention the fact that he could buy 2-3 houses for the price of the medical bill (Indiana is cheap) .... and his credit wasn't great even though he didn't carry much debt.

His way out was bankruptcy.

sometimes maybe if that patient is lucky and smart enough to know the inside tricks

The discount is not guaranteed.

Well she said the insurance covered everything but 500. That's still a lot.

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