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Comment by olyjohn | Hacker News Reader

I just had some bloodwork done, myself. My provider accidentally billed insurance, which had lapsed due to being laid off. I got my "Explanation of benefits" and it was $1000 billed to them, but I was given a $500 "discount." So I only owed $500... Cash cost was $50. Makes no goddamn sense.

Also I went in for a colonoscopy and an endoscopy. Insurance was billed for $14000. I got statements from 4 different doctors, and the facility where it was performed. None of the statements matched the explanation of benefits from the insurance company. And when I called each doctor, to pay them, they all told me that I didn't actually have to pay them what it said I owed. So I just ended up paying $2500 to the insurance company. It again, makes zero sense.

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It makes perfect sense. The prices are inflated with a few extra zeroes to try to force people to get any job with insurance. The big numbers are just to scare people. You can also turn negotiating with the hospital into a full time job and get the real numbers. If you're too unhealthy to do either of these then you can just die I guess.

Well, there is that. But there is also the fact that they charge you or your insurance company to smooth out other costs like $2,000,000.00 cancer treatment or for people who show up to the hospital, don’t have insurance, and the hospital has to treat them.

I’m reaching the point where I don’t really care if it’s private or public, but what we are doing today is the worst of both worlds. It either needs to be fully private, maybe with mandatory insurance purchase, or it needs to be fully public, though that has its own baggage.

“ But there is also the fact that they charge you or your insurance company to smooth out other costs like $2,000,000.00 cancer treatment or for people who show up to the hospital, don’t have insurance, and the hospital has to treat them”

I bet whatever cost these patients cause, the hospital will inflate this by an order of magnitude. It’s the same with charity care. Hey, my sticker price for an aspirin is $1000. I’ll give away 10 aspirin and I can get credit for $10000 charity.

A lot of that is tied into billing in general, even without the people who can't afford to pay for their care. When they send out an invoice for $50,000 for services rendered, even if the insurance company only ends up paying them a fraction of that, when it comes to accounting and taxes you can be sure they are using that $50,000 number for deductions and such when it benefits them.

This uncertainty of what things cost would kill me. It must be terrible!

We had a baby 2 weeks ago, which included 4 nights in the hospital before and after the birth, a surprise c-section, various specialists, follow ups, consultants and blood tests.

Our total outlay so far is about €30 for the parking at the hospital every day.

We have insurance, but we did not use it for the baby. I need to see a dermatologist next week. Cost will be €300, which I can claim back from my insurance afterwards. I just punch the doctor's name into my insurance portal, and they list the procedures and the amounts I'm covered for each.

If I asked my GP to refer me to a public dermatologist, I would have waited longer for an appt, but I would have only had to worry about parking at the hospital, everything else would be free.

I don't think the hospital expects to actually ever get paid what they bill out, or anything at all, if it's not paid onsite or by insurance.

>> I don't think the hospital expects to actually ever get paid what they bill out

OH YES THEY ABSOLUTELY DO!

When I was in-between jobs I had a medical emergency and I was on the ACA around the first year it was offered. I was billed above medicare rates so I was on the hook for ~40k after out of pocket max. They told me this limit is what insurance has to cover but hospitals can still bill above it. First they told me they could work on the prices and asked for my last 5 years tax returns. When they saw that I had dividend payments they said they couldn't help me and I owed them the $40k. I think that was the problem because even though I wasn't working in their mind if I had investments then technically I was not in need so they set up four-year payment plan and paid every penny with no cost reduction.

I probably did something wrong but to this day I didn't know what I would have done differently. The only people I could talk to were the hospital and they only cared about the hospital.

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I really don't believe you, but according to HN, I am supposed to trust in good faith you aren't lying.

Maybe you just don't have any assets or make very little money. I have equity and cannot just toss it to a collection agency and hope they forget. I also play by the rules, silly, I know, but I don't want to risk getting fucked some other way later in life.

This is called "balance billing" and the No Surprises Act usually prevents it, especially in emergency cases.

https://www.healthinsurance.org/glossary/no-surprises-act/

This happened in 2013, 9 years before the Act. Hopefully the Act prevents this kind of stuff. The medicare limit is what really confused me. If there is a limit insurance will cover up to, then how is it possible to exceed that limit?

Not for ambulances!

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