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from the meanwhile-don't-get-sick-or-hurt dept.
The bipartisan plan to end surprise ER bills, explained:
The policy proposal, which you can read here, essentially bars out-of-network doctors from billing patients directly for their care. Instead, they would have to seek payment from the insurance plan. This would mean that in the cases above, the out-of-network doctors couldn't send those big bills to the patients, who'd be all set after paying their emergency room copays.
The doctors would instead have to work with patients' insurance, which would pay the greater of the following two amounts:
- The median in-network rate negotiated by health plans
- 125 percent of the average amount paid to similar providers in the same geographic area
The Senate proposal would also require out-of-network doctors and hospitals to tell patients that they are out of network once their condition has stabilized, and give them the opportunity to transfer to an in-network facility.
[...] it's pretty good policy too! That's the general feedback I got from Zack Cooper, an associate professor at Yale University, who, along with his colleague Fiona Scott Morton, has done a lot of pioneering research to uncover how frequently and where these surprise bills happen.
"It is fantastic that they're doing something, and that it's bipartisan," he says. "It's one of those areas where we can agree what is happening now is not good, and this gets us 80 percent of the way to fixing it."
[...] "My concern here is that in-network rates are already quite high, so we're cementing that into the system," he says. "The current world gives emergency physicians tremendous power in negotiating higher in-network rates."
See also: Emergency room visit costs: what's the price of care?
(Score: 2) by Immerman on Monday October 08 2018, @10:35PM (15 children)
I don't see how it would be any worse.
Currently you get billed one of:
The in-network rate, to be paid by your insurer, if your insurer's network includes the provider
A completely outrageous rate, quite likely many times that amount, to be paid by you, if you don't have insurance, or aren't in-network
Under the new plan it sounds like that second number would be limited to 1.25x of the median amount billed to regional in-network insurers in the area. And it would be billed to your insurance.
Now, they don't say (in the summary at least) whether your insurer can pass that bill on to you, but even if they do, it's almost certainly substantially less than you would be billed otherwise.
Basically, these days doctor bills fall into one of two categories -
in-network, in which case your insurer pay the standard rates they've negotiated,
or
whatever number they make up, because there's absolutely no oversight, and nobody will even hint at the prices upfront so you can't possibly comparison shop
And that's not just for emergency care - even something like giving birth with no complications, where you have months to consider your options beforehand - no hospital will even give you a hint at what the uninsured price will be, and that price can easily vary by a factor of 10 or more between comparable hospitals in the same city. (and of course even the insured rate is several times the billed cost in any country with socialized medicine, but that's a whole separate conversation.)
(Score: 0) by Anonymous Coward on Monday October 08 2018, @10:59PM (14 children)
This is a myth. Try shopping around for some healthcare and saying you dont have insurance. It is almost guaranteed to be at least half the price quoted to someone with insurance and quite often is even less than the deductible they would otherwise pay. There are links elsewhere in this thread that go into detail about it.
(Score: 2) by Immerman on Monday October 08 2018, @11:26PM (6 children)
That has never been my experience. And shopping around isn't an option if they won't tell you the price beforehand.
(Score: 1, Interesting) by Anonymous Coward on Monday October 08 2018, @11:43PM
Well it has been mine. I actually discovered it on accident then found out people already knew about this "trick". If you have a choice, always say you don't have health insurance first.
(Score: 2) by PartTimeZombie on Tuesday October 09 2018, @12:00AM (2 children)
If it's emergency healthcare how is anyone even talking about shopping around? How would you even do that?
Last year when Mrs. PartTimeZombie fell down the stairs and broke her ankle, do you think I phoned several hospitals for a quote?
What I did was phone an ambulance which took her to the hospital where she was treated. At no point did I worry about the stupid concept of "in network" or "co-pay".
After several months of care, including two operations I had paid about $100 for some extra physiotherapy and whatever parking at the hospital cost because I had already paid for everything else when I paid my taxes.
(Score: 0) by Anonymous Coward on Tuesday October 09 2018, @12:10AM
You would first do it to go in for a non-emergency. Eg, the optometrist, dentist, dermatologist, or whatever. Then realize that you should be figuring out what you want to happen in an emergency beforehand. Here is an example:
http://selfpaypatient.com/2014/01/03/insured-patients-can-save-money-by-pretending-to-be-uninsured/ [selfpaypatient.com]
And if you still want that feeling of insured safety, just get a really cheap, high deductible plan for true emergencies and/or a health savings account.
(Score: 0) by Anonymous Coward on Tuesday October 09 2018, @09:21PM
The way you could do that is to compare prices in aggregate before the emergency, and then use the ER that worked best for you in terms of price/location.
However, since no one will give prices, you are left with picking the closest one because they like to not give you actual choices.
(Score: 2) by dry on Tuesday October 09 2018, @04:52AM
Do they not post prices? I'm in BC (every Province is slightly different). Took someone to emergency recently, big sign with prices, both for Canadian residents (just over $500 IIRC) and higher for foreigners ($700 or $800 IIRC). Same at the Drs office, a price list of stuff that isn't covered, eg $100 or so for a work related physical (professional driver, airline pilot etc), x amount for a sick note etc. I didn't pay much attention to the actual prices.
Regular stuff is supposed to be billed at the same rate as the government pays as well, unless it has changed. Canadians often aren't aware that their medical doesn't cover them if they're not in their Province of residence and at least in BC, you have to register and if not poor, pay (about $70 a month for a single person, might be payed by your employer).
(Score: 0) by Anonymous Coward on Tuesday October 09 2018, @07:52PM
That's because your physicians are still honest, mostly.
Find me anyone, anywhere who will rightfully and honestly tell you what the bill to fix your car will be beforehand. Or your washing machine.
The best you will hope for is someone to tell you, "Well, if it is *X*, and *X* only, and there are no other complications that take more time, it will cost $Y." More likely you will hear, "It depends on what is wrong." Straightforward things like getting your oil changed, where they know there is no way it will take more time or knowledge or skill, those can be quoted. But medicine? Yeah.
What you'll hear from an honest practitioner is, "I won't know what it will cost until after we've had our meeting because I don't know how my of my time your health will take for me to work through your issues and I don't fully know what if any therapy or diagnostics you will need in my office at the time of your visit."
Anyone who tells you upfront, "Yeah, we'll see you for $Y" is likely overcharging on average - covering the more complex cases up with charging less complex more. Anyone who shops around for their healthcare on discount is likely to get discount healthcare.
(Score: 0) by Anonymous Coward on Tuesday October 09 2018, @12:08AM (6 children)
Paying cash for my bloodwork labs cost like $700. Cost to insurace? $40 billed to insurance. A whole fucking order of magnitude less.
Office visits same thing but less dramatic. Without insurace? $125. With insurance? $50 billed to insurance, plus my co-pay.
Is there a specific procedure or state or geographical area where this is true?
(Score: 0) by Anonymous Coward on Tuesday October 09 2018, @12:12AM (5 children)
Does the place know you have health insurance?
(Score: 0) by Anonymous Coward on Tuesday October 09 2018, @01:57AM (4 children)
Was not insured at the time.
(Score: 0) by Anonymous Coward on Tuesday October 09 2018, @02:04AM (3 children)
Whoops! That's wasn't the preview button!
I meant that I am comparing the cost from when I did not have insurance vs. my current situation with insurance.
Though it occurs to me... you're not taking advantage of sliding scale programs and other charities meant for low income people without insurance?... naah, an upstanding, wealthy capitalist like you would never do such a thing.
(Score: 0) by Anonymous Coward on Tuesday October 09 2018, @04:27AM (2 children)
No, I meant simply saying you don't have insurance.
It sounds like maybe whoever you went to had some really crappy contract with the insurance company that required them to charge you x times more. Or maybe, was it before and after obamacare?
(Score: 0) by Anonymous Coward on Tuesday October 09 2018, @09:29AM (1 child)
Scenario 1: Before Obamacare. Without insurance. $700 for bloodwork. What magic words was I supposed to say?
Scenario 2: After Obamacare. With insurance. $40.
(Score: 0) by Anonymous Coward on Tuesday October 09 2018, @10:11AM
No idea, some places might have contracts with insurers so they need to charge you more though. Dont go to those places.