Website article on lawsuits over hospital balance / surprise billing

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sawhorse
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Re: Website article on lawsuits over hospital balance / surprise billing

Post by sawhorse » Fri Oct 12, 2018 4:14 pm

toofache32 wrote:
Fri Oct 12, 2018 3:16 pm
White Coat Investor wrote:
Fri Oct 12, 2018 2:40 pm
sawhorse wrote:
Fri Oct 12, 2018 1:54 pm
White Coat Investor wrote:
Fri Oct 12, 2018 1:20 pm
I purchased health care this week in an urgent situation. The practice does not accept any insurance. I was seen and taken care of. They told me it cost $532. I gave them my credit card and paid the bill and thanked the doctor for seeing me.
How easy was it to get the price ahead of time? Was it a complex situation with multiple providers, tests, equipment, etc? In my experience if it's a simple office consultation with a single provider, it's relatively easy to get a price in advance. But once you add testing, equipment, procedures, multiple providers, etc then it becomes impossible.
They gave me the office visit ($192) price up front, but noted it didn't include procedures, which I knew I needed. I guess I could have asked about it and they could have told me because they told me at the end of the visit.

But I didn't feel like shopping it around to the two other urgent cares in the area to save a few bucks. I wanted to get it done and get back to my vacation. Too bad I wasn't home where I could have been seen by my partners or with my usual rather extensive first aid kit or I would have walked my wife through the procedure.
That's how my office works. Patients are given a fee up front for the office consult ($235) which includes any and all xrays which are sometimes needed. Many patients end up needing an office procedure such as a biopsy. They are quoted a fee for this also (about $500 or about $1000 if more complex). If you do the procedure on the same day, then I only charge for the procedure so you save the $235. Patients seem to really appreciate how fees are known up front and we NEVER ask for more money later. Back when I was in-network with insurance, I was not able to give true fees up front, only estimates based on inaccurate insurance info which was often wrong. People complain about lack of price transparency and don't realize this is an INSURANCE phenomenon.
I would love if all doctors, hospitals, and labs did this. Even with a doctor that didn't take any insurance, it was a struggle to get a price in advance. I easily got a price for the consultation, but then when the doctor ordered a test to be done in the office, she couldn't say how much it would cost. I had to wait for the secretary to return, then the secretary was like, "I think it's either 95 or 75. Let's say 75." I was surprised she didn't consult a list.

As the second link in the original post shows, hospitals guard their price list so much that they wouldn't even hand it over to a court.

Patients are hopeless if they want a price in advance.

Then there is the issue of urgent situations in which the patient isn't in a position to ask for the price in advance or isn't in a position to refuse.

boglesmind
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Re: Website article on lawsuits over hospital balance / surprise billing

Post by boglesmind » Fri Oct 12, 2018 4:24 pm

brcarls wrote:
Fri Oct 12, 2018 4:01 pm
toofache32 wrote:
Fri Oct 12, 2018 3:29 pm
Completely agree there is little understanding of how things work in that post. If they simply cancelled his surgery at the last minute since that special anesthesiologist was not available, he would be here complaining "I took a day off work and they didn't do my surgery so they need to pay me for a day of lost wages." Can't please everyone.
Not even close. If they had informed me that the anesthesiologist was out of network, I would have walked out of pre-op. I would have had to pop Vicodin like candy for another month while I sought care elsewhere, but that's better than risking financial ruin.

They tried to take advantage of me while I was at my most vulnerable, despite assuring me 2 hours before the procedure that there would be no financial surprises. I even made the clueless admin, who took my pre-payment in full, initial on the contract where I wrote in that I did not consent to care from out of network providers.... but they did not care and did it anyway. That is not on the insurance company, that is on the unethical doctors and administrators who deliberately chose to prey on me.
This.
In the Virginia case quoted by OP, judge Williams commented
The opinion is Dennis v. PHC-Martinsville Inc. (VLW 016-8-050).

The hospital failed to meet its burden of proving that the parties mutually had made a binding contract, the judge said. In the first place, the Financial Responsibility Agreement was a “contract of adhesion,” the judge decided. He quoted U.S. Supreme Court Chief Justice John Roberts: “‘Your money or your life’ is a coercive proposition, whether you have a single dollar in your pocket or $500.” ...
Williams found the hospital’s secrecy about its charges also suggested the contract was not a product of mutual agreement.

“No definition of the word ‘mutual’ encompasses a situation in which all of the information about a critical contractual element is held by one of the parties, who refuses to share it with the other party,” Williams said.
I hope the case is appealed all the way to the Supreme Court where PHC-Martinsville Inc loses. Likewise, I hope the challengers to the CA bill AB 72 go all the way to the Supreme Court and lose.

Boglesmind

tj
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Re: Website article on lawsuits over hospital balance / surprise billing

Post by tj » Fri Oct 12, 2018 4:30 pm

Patients are hopeless if they want a price in advance.
It wasn't hard for tfb to do this:

https://thefinancebuff.com/shop-healthc ... rance.html

sawhorse
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Joined: Sun Mar 01, 2015 7:05 pm

Re: Website article on lawsuits over hospital balance / surprise billing

Post by sawhorse » Fri Oct 12, 2018 4:41 pm

tj wrote:
Fri Oct 12, 2018 4:30 pm
Patients are hopeless if they want a price in advance.
It wasn't hard for tfb to do this:

https://thefinancebuff.com/shop-healthc ... rance.html
Now imagine doing that for dozens of codes while you're sick and/or in an urgent situation. It's those situations that cost the most money, not situations in which you're getting a single non-urgent MRI and don't have mobility and speech problems that would prevent you from doing the things in that blog.

In addition, the blog post talks about prices for in network facilities and services. This thread is about patients who get charged as out of network. That post doesn't help you if you're trying to get an out of network price, and certainly not if you're in a situation that can't wait that long.

If the hospital in the court case wasn't even willing to disclose its prices to a court, what are the chances it would have disclosed it to an individual patient?

I think relatively healthy people like The Financial Buff have no idea what it's like for people who have serious medical needs, i.e. people who most need to be concerned about health costs. Doing basic tasks of living is a struggle. I physically, cognitively, and mentally cannot jump through all the hoops I would need to in order to get prices, fight insurance companies and billing departments, etc. It shouldn't and needn't be so difficult.

Here is my experience trying to get lab prices. Nispirius and others add their own experiences.

viewtopic.php?f=2&t=258709

brcarls
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Re: Website article on lawsuits over hospital balance / surprise billing

Post by brcarls » Fri Oct 12, 2018 5:36 pm

Our system in the US really is hopelessly broken. Lots of people claim or hint that it's a free market, but it is not at all.

Most people cannot choose their insurance company, their employer chooses.
Most people cannot choose their doctors, their insurance company chooses.
Prices are secret or maybe even unknowable because providers play the game of throwing out a price that is ridiculously high seeing what the insurer will pay. They certainly don't want to accidentally ask for less than the max.

We need to bring market forces to bear by doing drastic things which might include some of the following:
1) ban employer provided health insurance.
2) ban direct billing of insurance by providers so that patients care about prices (and providers are relieved of the monstrous administrative burden).
3) require up front and transparent prices so that market forces can be brought to bear on providers .
4) ban discriminatory pricing (e.g. same price regardless of insurer (including none)).
5) remove minimum coverage requirements on insurance.
6) improve supply of health care by vastly expanding the care which can be provided by people other than doctors.

TropikThunder
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Re: Website article on lawsuits over hospital balance / surprise billing

Post by TropikThunder » Fri Oct 12, 2018 6:33 pm

brcarls wrote:
Fri Oct 12, 2018 4:01 pm
They tried to take advantage of me while I was at my most vulnerable, despite assuring me 2 hours before the procedure that there would be no financial surprises. I even made the clueless admin, who took my pre-payment in full, initial on the contract where I wrote in that I did not consent to care from out of network providers.... but they did not care and did it anyway. That is not on the insurance company, that is on the unethical doctors and administrators who deliberately chose to prey on me.
Never attribute to malice that which is adequately explained by incompetence.
Hanlon's Razor.

I'm certainly not taking the hospital's side, but I doubt this was deliberate. I work in a hospital. I know how little the departments speak to each other. I guarantee that the admin you dealt with for the finance side had no idea that the anesthesiologist was going to be changed. How would they? "Dr. X isn't available as expected, can Dr. Y cover this surgery?" "Sure, just don't forget to tell the Patient Financial Services liaison." Doesn't happen. And there would be no reason for the incoming anesthesiologist to know that the patient had signed a form withholding consent for OON providers. Yes, you were done wrong, but there is enough incompetence and poor processes to go around that we don't need to get distracted by assigning malevolent motives.

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Re: Website article on lawsuits over hospital balance / surprise billing

Post by LadyGeek » Fri Oct 12, 2018 7:34 pm

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