You’re Insured But Still Owe $109K For Your Heart Attack

[KenH]

"In the wake of his heart attack, Calver fell victim to twin medical billing practices that increasingly bedevil many Americans, even as legislators have tried to protect them: surprise bills and balance billing.

Surprise bills occur when a patient goes to a hospital in his insurance network but receives treatment from a doctor that does not participate in the network, resulting in a direct bill to the patient. They can also occur in cases like Calver’s, where insurers will pay for needed emergency care at the closest hospital — even if it is out-of-network — but the hospital and the insurer may not agree on a reasonable price. The hospital then demands that patients pay the difference, in a practice called balance billing."

A Jolt To The Jugular! You’re Insured But Still Owe $109K For Your Heart Attack

 

[Gold Dragon]

$20000 just for a single stent is ridiculous. That doesn't even include its insertion, just holding the stent in your hand. In Australia, if a surgeon charges excessive fees, the Royal Australasian College of Surgeons can file a complaint on behalf of the patient to the Medical Board. Patients are encouraged to report these cases. Doctors like that damage the reputation of the entire profession and should have their licensure challenged.

https://www.surgeons.org/media/20023066/2014-10-30_pos_fes-pst-036_excessive_fees.pdf

The average cost of the entire procedure to insert a stent in NSW is $7800 AUD (around $5700 USD). I'm not sure if it includes recovery time in hospital but I am assuming it does as most single stent insertions do not require a prolonged admission.

Cost of Care in NSW Hospitals

Granted this patient had 4 stents inserted but given the inappropriate billings and questionable practices, I wonder if all 4 were actually necessary.

How many stories of patients going bankrupt that don't make the news does it take before the "market" can adjust to know that you need to avoid this hospital or that doctor? How do you have time to do your market research while your cardiac tissue is dying by the minute? When you find out that the hospital you are in is going to gouge you, how do you organize transport away from them in a timely matter so that you don't die before getting to a hospital that won't gouge you? Why is this an acceptable way of doing business while people's lives are on the line?

 

[KenH]

Why is this an acceptable way of doing business while people's lives are on the line?

It's not. Medical insurance in the United States is a broken system that is far behind those of other first world countries. It will be hard to fix as people tend to be afraid of change even if the change is to something better.

 

[carpro]

"Reasonable and customary" is the language here. If a charge exceeds that, it can be protested, a reduction can be forced. But that is an entirely different issue from "out of network". In an emergency when the insured has no choice of facility or doctor, out of network differences are usually waived. In this case, I believe the man can easily beat the charges, but it will take a little effort.

 

[Revmitchell]

It's not. Medical insurance in the United States is a broken system that is far behind those of other first world countries. It will be hard to fix as people tend to be afraid of change even if the change is to something better.

change is not the problem, it is the type of change that is the problem. If it is federal government oriented change then it will never be acceptable.

 

[KenH]

If it is federal government oriented change then it will never be acceptable.

To you. It is to me and lots of other folks. But I don't expect Medicare-for-All during my lifetime. Of course, it will be irrelevant to me since I will be eligible for Medicare in about 26 months and my wife about 61 months after me anyway.