this post was submitted on 17 Jun 2024
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[–] [email protected] 60 points 4 months ago* (last edited 4 months ago) (6 children)

The flip side of this debate is that by banning all medical debt from credit reports, patients will have no incentive to pay their medical bills and instead just skip them entirely, forcing hospitals to demand payment up front, raise prices even further, etc.

What do I say to that? Fuck 'em.

First, stop jacking up the prices of mundane items. Asprin shouldn't be costing me $20+ per pill just to cure a headache. That doctor that stopped in for 3 seconds to ask how I was doing shouldn't run me $2500.

Second, make sure bills are (a) accurate, and (b) easy to read. Don't just stick some medical jargon and some huge number as a line item and expect patients to just blindly pay it without question. At best, expect them to question it (which is how most of the inaccuracies are found), and at worst, they'll just ignore the bill entirely, especially if it's out of their financial reach. Giving the patient a clean, easy to understand, reasonable and most importantly accurate hospital bill would at least give hospitals some chance of getting some of the money.

Third, if they want to go after someone for the money, go after the god damned insurance companies. Tell them to cover what they said they were going to cover. Tell them to stop weaseling out of paying by using semantics and doublespeak to get away with not paying on a technicality. Tell them to stop with the sky-high deductibles. But you were never going to get any of the money by harassing and ruining the credit of a mother of two who was already struggling to make ends meet before whatever health issues brought her to the hospital in the first place. That $12,000 bill you sent her? Might as well have been for $12,000,000,000. You had the exact same chances of that person being able to pay off either one in the first place: 0.

And finally, stop sending multiple bills that are days, weeks, or even months apart. I don't care how "independent" your doctors are or whatever the case is. I should expect to get one hospital bill, not half a dozen spread out over months. How you accomplish this shouldn't be my problem. But if you're going to continue doing this, don't be surprised when those bills go unpaid or are lost in the shuffle because the patient thinks they already handled that and just proceed to ignore it. Patients shouldn't suffer because hospitals can't figure out how the hell to even bill their patients properly.

If hospitals want their money, let them get it from the insurance companies that we're paying thousands of dollars a month to in the first place, not the people who never wanted to be in a situation where they needed hospital care and would never have the resources to pay it back in the first place. Let the patients try to rebuild their lives, and go after the insurance companies that we're paying to handle this for us.

[–] [email protected] 28 points 4 months ago (2 children)

Or even better, single payer where the patient doesn't have to do anything about the cost. Why should cancer patients and people with traumatic brain injuries need to worry about costs?

Why should single mothers? Why should any person who needs treatment?

[–] [email protected] 11 points 4 months ago (1 children)

This I agree with, but it's not the system we have. Right now, under our current and shitty system, hospitals have two options: They can go after the insurance companies or they can go after the patients. I say fuck 'em and make them go after the insurance companies if they want their money. Isn't that what we're supposed to be paying them for? And if hospitals don't like the fact that they have to deal with insurance companies if they want to get paid at all, then they can join the push for a single payer system in this country that ensures they get paid without having to harass and ruin the lives of the patients.

[–] [email protected] 4 points 4 months ago

FWIW, Cigna insurance tells its insured people that health care providers are never supposed to send bills to patients.

[–] [email protected] 7 points 4 months ago (1 children)

This is really the only logical answer. When else is someone allowed to force you to agree to unknown terms at the consequence of your health? That matches every definition of extortion I can find...

[–] [email protected] 12 points 4 months ago (1 children)

When else is someone allowed to force you to agree to unknown terms at the consequence of your health?

You're not even "agreeing" to the unknown terms a lot of the time. Your "agreement" is just assumed. How the hell can you "agree" to anything if you're unconscious and being brought to the hospital in an ambulance after a car accident? Or when you're literally in the middle of a heart attack?

99.99% of people who are going to hospitals aren't exactly in any condition to shop around, make informed choices, or "agree" to anything at all, and most of the services they're being billed for were most likely for services rendered while the patient was still incapacitated or otherwise unable to agree to anything. And what if you disagree? You die? And if you don't like the prices your hospital is going to charge, what are you going to do if it's the only hospital in your area?

If you were to enter literally any other "agreement" in this country when there are no competing hospitals in your area to shop around for, the terms of the agreement are unknown until weeks or months after services are rendered, and you are in no way capable of giving informed consent at the time the agreement is made, it would be thrown out of court for being made under duress and for being too one-sided.

[–] [email protected] 2 points 4 months ago

Exactly. I do agree with you, except possibly on your comments about only doing what insurance pays for. I feel that would go the opposite of the way I imagine you are picturing.

As you said, if someone is dying, unconscious, etc, nobody will be able to tell what, if any, insurance you have. Also, with some of the crappier plans out there, especially the barebones "Anti-Obamacare" plans red states are pushing, you might be having a very unpleasant visit if no one from insurance can confirm in a timely manner what they will cover, or if you can only get an Ibuprofen after your surgery instead of a narcotic, etc.

I assume your plan would be more like, the medical team does the same job they'd do on you as anyone else, and then insurance is stuck with that bill. But as we all have some form of tiered insurance as it is, if we have any at all, that's about as moot as discussing single payer. And that is why single payer is the only reasonable way to go forward. Any games going on are between the hospital and the fed, where they belong. We're all mostly out of the equation then. Except for medical procedures still deemed political, in which the list for that seems to be growing and ever changing as well. But that's a story for another time....and not from me, that's too heated for me!

[–] [email protected] 18 points 4 months ago* (last edited 4 months ago) (1 children)

Hospitals jacking up prices is kind of a function of the insurance industry. Insurance says "We're only going to pay you ten percent of what you've actually billed," so health care providers take the amount that they're willing to receive for the services and add a zero to the end. This becomes the "retail price," and you don't get access to the insurance price. Only the insurance companies do, and you have to pay them a monthly "protection fee," whether you require healthcare that month or not.

[–] [email protected] 2 points 4 months ago (1 children)

Do insurances only pay a set % of charged? Because in that case hospitals would just charge whatever arbitrary amount they wanted.

I think insurances set hard limits on paying individual types of tasks and procedures. Hospitals and doctors bill whatever they want, insurance pays X that's allowed, tells the insured what they owe, and the rest is written off by the doctor because no one is obligated to pay it.

[–] [email protected] 1 points 4 months ago

This is what procedure codes are for. Technically, they only apply to Medicare but im sure insurance uses them. As far as I know there is a catalog of every possible procedure and the insurance company has an agreement with the hospital that they will pay a specific amount for each. There are also loose guideleines as for what procedures are appropriate in what circumstances.

Your hospital send insurance a bill with procedure codes, then insurance decides whether the procedure appears appropriate and in theory pays

That’s why one of the first things to try is for the medical personnel to re-code your record. maybe there’s a similar one that’s more appropriate to the illness or to what the hospital did

[–] [email protected] 11 points 4 months ago (1 children)

Just because it's not on a report doesn't mean providers have no recourse when it comes to seeking compensation. If they so choose they can take anyone to court and obtain a legal judgement. The frequent calls and letters from collectors are no picnic either.

The biggest issue I have with paying bills on time is the stupid billing systems. Like 30% of the time I either can't find the payment option in their portal, login doesn't work, don't see any record of services (i.e. just give us money), or the total amount owed is different from the paper bill. Life is distracting, and if I can't assess what I'm paying for and get to the "Submit Payment" button in 10 mins then don't expect me to remember 8 hours later when I again have free time.

[–] [email protected] 3 points 4 months ago

Just because it’s not on a report doesn’t mean providers have no recourse when it comes to seeking compensation.

No, but most of the time it's simply not worth it for hospitals to fight. Either they'd spend more time and money on lawyers, arbitration, etc. than they'd be able to collect if they win, or the patient is poor and all but judgement-proof.

If they so choose they can take anyone to court and obtain a legal judgement. The frequent calls and letters from collectors are no picnic either.

If I recall reading the updated proposal from the CFPB correctly, it's supposed to be putting a stop to the debt collectors too. The only recourse left, if I'm reading everything correctly, would be for the hospitals to sue patients directly, and that would probably only be for bills high enough to make seeking legal action worth it and if they feel the patient has the resources to pay. The latter is the most important part -- whether the bill is for $100 or eleventy billion dollars won't matter if the patient is, for example, and elderly woman on disability with no possible way to repay anything.

[–] [email protected] 4 points 4 months ago

Had to have my ankle put back together in November after breaking it super bad. Almost all of the bills have gone to collections because there are too many separate bills for me to keep up with. I'd also just get them randomly and new ones keep popping up every so often. Sometimes I cry just thinking about it.

[–] [email protected] 1 points 4 months ago

forcing hospitals to demand payment up front, raise prices even further, etc.

Which means for scheduling care they'll have to either explain all the charges or they won't get business. But for emergency care they are still fucked. They can't deny emergency care regardless of payment ability.

[–] [email protected] 1 points 4 months ago

That's a whole Lotta words to say universal Healthcare