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Comment by shiroiushi | Hacker News Reader

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His company was not an outlier; you have similar stories from Signa, AIG, and Blue Cross Blue Shield. BCBS had unveiled new rules to stop covering anathesia during surgery after the scheduled end time, regardless of if the surgery was still in progress. Those were rolled back after the killing.

American healthcare is like this. Your doctor wants to give you some treatment, some other person decides how much it costs, then insurance, who you paid ahead of time, who you are legally required to have, who has never and will never see you, decides that it’s too expensive to pay out. Even though that’s what insurance is for. They get rich off of this; you suffer.

The thing we pay for called "health insurance" is really not insurance. Real insurance covers catastrophic unpredictable losses up to a pre-defined limit. That's all. What we have is some sort of forced pre-payment for routine medical care combined with some limited coverage for the unknown.

It’s a maintenance and repair plan that has a massive terms and conditions

What's stopping you from getting a high-deductible plan and paying cash for routine care? I'll admit you have to negotiate down the fake prices yourself.

Because there is nothing about a high-deductible plan that insures better against catastrophic outcomes.

I do have an HDHP+HSA plan, but you still have to run all your routine care through the insurance, (a) so they negotiate a lower price and (b) so it is applied to your deductible.

Truly "paying cash" for routine care would be difficult as most doctor's offices have no idea how to quote a cash price for services, unless you go to one of the very few cash-based practices.

> BCBS had unveiled new rules to stop covering anathesia during surgery after the scheduled end time, regardless of if the surgery was still in progress. Those were rolled back after the killing.

Sounds like some positive outcomes already.

That was going to be rolled back anyway. There is zero chance it could ever have applied to anyone.

You paying more for surgery is not a positive outcome, unless you are an anesthesiologist, in which case: well played, your trade group dues paid off mightily here.

So if you're under the knife and a surgery is taking longer than expected, which would you prefer?

a) The surgeons just stop the procedure early and close you up

b) They continue but send the anaesthesiologist home, or

c) They continue but you wake up to a massive surprise bill that you need to pay out of pocket?

Are you being serious? Rationing anesthesia during surgeries is not a thing.

The least expensive general anesthesia surgeries I can find already greatly exceed the out-of-pocket annual maximums for ACA market insurance plans (which have worse out-of-pocket maximums than the employment-based insurance plans most people have). You are not paying the money Anthem was trying to get anesthesiologists to stop overcharging!

This is a dispute between two giant corporations, and people are inexplicably (and literally murderously) taking the side of the one that is making more money, and is resisting Medicare's guidelines.

I'm not kidding: the messaging heist anesthesiologist trade groups pulled off here is unreal. They're some of the highest-paid specialists in the entire profession, and people are literally talking about giving their lives to protect their right to overbill you.

What I'm failing to understand in your argument is how this relates to the scheduled end time for the surgery which presumably can be different from the actual end time. If X hours are planned and it takes X+2 hours, who pays for the 2 hours? If the insurance doesn't pay for it, what does the out of pocket maximum have to do with it? Are the anaesthesiologists just legally compelled to finish the procedure without billing for the extra time? If so, what incentive does this create vs. simply negotiating down the rate?

None of this has anything to do with what's actually happening in the OR. The most common surgery performed in the US is a laparoscopic appendectomy. The low end of the average cost of that appendectomy as an outpatient procedure significantly exceeds out-of-pocket caps for insurance.

* This is not money you were ever going to pay.

* There is no such thing as cutting anesthesia off early because of a billing dispute.

You are getting rolled by a professional trade group for some of the most highly compensated, well-off people in the American economy. We might just as well take up arms against the rapacious costs of M&A litigation in the finance industry.

I have no personal connection to this issue at all apart from living in the US. Rather than fixating on your perception that I do, maybe you could contribute to the discussion by actually answering any of the questions I raised in your reply to my comment?

I just answered your question directly.

"This is not money you were ever going to pay."

I don't see why. Don't out-of-pocket maximums only apply to covered care?

Is that what happens when Medicare, which pays for the overwhelming majority of all surgeries, denies anesthesiology bills exceeding CMS limits? Seniors just pay for their own anesthesia? No.

I honestly don't know, but if not I would like to understand why.

Yes you do know! Do you read lots of stories about seniors being stiffed with huge anesthesia bills? No. Because that doesn't happen!

Okay, but granting that, why?

You forgot:

d) Stop the anaesthesia and continue the procedure with you regaining consciousness.

This is not a thing. You cannot simply continue surgery with less anesthesia. The issue here is that CMS has guidelines for the anesthesia requirements for different procedures, and anesthesiologists have become notoriously for surprise billing for much higher amounts than those guidelines.

Again: this is a dispute about bills patients don't pay. The most routine imaginable surgeries --- appendectomies, laparoscopic gall bladder removals --- all have average costs that greatly exceed average out-of-pocket caps for insurance.

CMS is far from authoritative on what it takes to keep a particular individual under. The practitioner is ultimately the one with authoritative knowledge. CMS is not in the operating theater.

Now if what we need is to deal with a rash of insurance fraud, insurers are more than welcome to hire people to sit in on the theater to gain more representative data. But let's be real here. Insurance is more interested in improving their take home spreadwise rather than improving patient outcomes.

And I beg to differ it doesn't happen. I remember quite vividly my wisdom teeth being extracted. I was just under threshold for being able to do anything about it, but awake and aware for the entire thing. Anaesthesia is not something to screw around with.

CMS is Medicare. Your wisdom tooth extraction was almost certainly not really general anesthesia. Were you intubated? During an extraction? I doubt it.

Same here for my wisdom tooth but very clearly remember them mentioning there were two options (one like you described and one where I would be out completely). Absolutely zero connection to the current discussion.

d) Overhaul of medicine in the US that makes timing life-saving care less sensitive to scheduling and profits

There's a long discussion about this on another thread, but if you're complaining about the BCBS anesthesia thing, you should look into how much you actually understand medical billing, because your complaint would also imply you find Medicare unconscionable as well.

Okay. Deal.

they were an outlier. as has been discussed, they denied claims twice as often as is average https://www.bostonglobe.com/2024/12/05/data/unitedhealthcare...

These companies also outsource to middlemen companies that do some of the claim denying dirty work for them (see evicore). That’s why they all universally provide a bad service. But I have to say, Aetna is by a long shot worse than others. Look up stories of moms being denied coverage for a routine delivery. Aetna seems to regularly deny first, and then force these exhausted and vulnerable women through long drawn out appeals process. It’s just a way for them to delay payments and change their cash flow. Executives should be in jail.

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