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Old 10-31-2014, 11:12 AM   #81
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Originally Posted by pb4uski View Post
Even pre-ACA maximum out-of-pockets were a lot less than $40-50k, so how could this possibly happen if someone has insurance? especially if they stay within network.
Our COBRA conversion policy rates were over $2K a month. I don't remember the exact premiums but they were around $2,300 hundred a month, so there is the first ~$27K just for premiums alone, plus we had out of network charges, hit the OOP max and assorted other medical bills for various family members throughout the year besides the major surgery. We needed a relatively rare type of surgery so we went to go to an out of network surgeon who didn't take any insurance but performed a thousand of this kind of surgery or instead of a network non-expert, so there was $9K out of pocket plus there were other non network charges even though it was an in network hospital.

Our COBRA policy started out at a manageable ~$1K month for reasonable insurance, then jumped to over $2K for medical, dental, hearing and mental health policy the next year, then the COBRA conversion policy went to even more for medical alone. PreACA, with pre-existing health issues, we could not get individual policies.

Here is a link from Kaiser of medical debt for people with health insurance:
http://kff.org/private-insurance/rep...lth-insurance/
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Old 10-31-2014, 11:35 AM   #82
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Originally Posted by Mulligan View Post
The local newspaper here recently had an article about the high rack rate costs. The answers by the local hospitals was long and convoluted, but they all said in unison clearly that no one ever pays anywhere close to those prices for the services whether it be insured or cash payers...
So patients get billed those amounts but then are supposed to know that they really don't have to pay for the charges they were billed? How does that process work? I'd like to see a flow chart on that. Step A - patient receives outrageous bill. Step B - knowledge springs forth into their heads from some sort of divine consciousness and they intuitively know they don't have to really pay the bill?

All our medical bills from last year had due dates and pre-printed threats on the billing forms that unpaid bills past a certain number of days would be turned over to a collection agency.
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Old 10-31-2014, 11:44 AM   #83
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So patients get billed those amounts but then are supposed to know that they really don't have to pay for the charges they were billed? How does that process work? I'd like to see a flow chart on that. Step A - patient receives outrageous bill. Step B - knowledge springs forth into their heads from some sort of divine consciousness and they intuitively know they don't have to really pay the bill?
Actually, they really hope you do pay the whole bill. That's the reason for the bill in the first place. It's like buying new (or used) cars....the price is always negotiable.

One poster (Travelover?) here recently mentioned a bill for a child that they thought had swallowed some non-prescription pills and went to ER, was admitted for observation overnight and was billed $55K. I don't recall if that was said to have been fully paid, but, it's outrageous. My entire hip replacement was not that expensive.
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Old 10-31-2014, 12:02 PM   #84
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Actually, they really hope you do pay the whole bill. That's the reason for the bill in the first place. It's like buying new (or used) cars....the price is always negotiable.

One poster (Travelover?) here recently mentioned a bill for a child that they thought had swallowed some non-prescription pills and went to ER, was admitted for observation overnight and was billed $55K. I don't recall if that was said to have been fully paid, but, it's outrageous. My entire hip replacement was not that expensive.
Well, I have extensive experience negotiating all sorts of contracts from my business and last job - employment contracts, software vendors, consulting agencies, etc. Maybe I don't have more experience at contracts than most posters here but probably more that 95% of the general population. I can tell you the out of network bills that came as a surprise to us after the fact, the providers wanted their billed amounts and what negotiating power did I have at that point or even the knowledge to know what really was a reasonable amount? The insurance still pays on non-network charges but only a fraction of what was billed.
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Old 10-31-2014, 12:14 PM   #85
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So patients get billed those amounts but then are supposed to know that they really don't have to pay for the charges they were billed? How does that process work? I'd like to see a flow chart on that. Step A - patient receives outrageous bill. Step B - knowledge springs forth into their heads from some sort of divine consciousness and they intuitively know they don't have to really pay the bill?

All our medical bills from last year had due dates and pre-printed threats on the billing forms that unpaid bills past a certain number of days would be turned over to a collection agency.
Common knowledge around here. The difference between paying the first bill right when it arrives vs waiting a few months and then pay the 'adjusted' price can amount to the price of a new car.

No one I know pays the bill right away. Of course, they won't complain if you do.

Just last week DW got a small bill ($48) from a procedure in April. She called and they said: "oh, forget about it; the insurance just paid it"
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Old 10-31-2014, 12:17 PM   #86
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Common knowledge around here. The difference between paying the first bill right when it arrives vs waiting a few months and then pay the 'adjusted' price can amount to the price of a new car.

No one I know pays the bill right away. Of course, they won't complain if you do.

Just last week DW got a small bill ($48) from a procedure in April. She called and they said: "oh, forget about it; the insurance just paid it"
I called them many times to try to get the bill lowered. They did rebill the insurance and got a bit more, and settled for less than the full amount many months later. But they were not going to go to zero after insurance. I tried that repeatedly and they made it very clear if we didn't reach an agreement it was going to collections. So was what I paid reasonable? Was the insurance company's payment reasonable and I got ripped off? Who really knows? Is there a surgery support provider equivalent to gas price buddy? They kept trying to get me to pay just a little. My husband said it was to reset the clock on the time on how long they could collect:

http://www.bankrate.com/finance/debt...ld-debt-1.aspx

So they do this for a living and have all the knowledge and know all the tricks.

When I used to hire contractors I knew the going rate. I knew what I paid for other contractors with equivalent experience. I could negotiate the rates and turn down people who asked for too much and hire someone else. The contractors with the exorbitant rates didn't come into the office and do work while I was unconscious and bill me whatever they wanted later.

I don't know where all these wonderful hospitals and providers are who write off the medical bills of the patient portion. The people in the Kaiser link above didn't seem to find them either. Medical bills are the #1 reason for bankruptcy in the U.S., even for people with health insurance:

http://www.cnbc.com/id/100840148#.

"Meanwhile, NerdWallet found, 15 million people will deplete their savings to cover medical bills. Another 10 million will be unable to pay for necessities such as rent, food and utilities because of those bills."
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Old 10-31-2014, 12:45 PM   #87
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Originally Posted by daylatedollarshort View Post
So patients get billed those amounts but then are supposed to know that they really don't have to pay for the charges they were billed? How does that process work? I'd like to see a flow chart on that. Step A - patient receives outrageous bill. Step B - knowledge springs forth into their heads from some sort of divine consciousness and they intuitively know they don't have to really pay the bill?

All our medical bills from last year had due dates and pre-printed threats on the billing forms that unpaid bills past a certain number of days would be turned over to a collection agency.

I think the debate is really a distinction without a difference as we all agree the system is wrong and too expensive. All I know is if it happens to me with crazy pricing and out of network charges slapped on me despite my due diligence there will be challenges, negotiations, stalling, "take to it collections, I don't ever need credit again anyways", "$5 a month payment for life, etc.....Isn't this how a normal medical payment system is supposed to operate?


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Old 10-31-2014, 02:31 PM   #88
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DH had surgery over the summer and the only outstanding uncovered item was $185 for "self administered drugs" whatever that was...
I too am expecting a bill for that. "Self administered" drugs are those that the patient requests and receives but is not medically necessary. In my case it was Tylenol for a couple of headaches and a sleep aid. There was a noisy dementia patient down the hall who slept all day and yakked all night. Not a whole lot the staff could do about that.
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Old 10-31-2014, 02:48 PM   #89
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I too am expecting a bill for that. "Self administered" drugs are those that the patient requests and receives but is not medically necessary. In my case it was Tylenol for a couple of headaches and a sleep aid. There was a noisy dementia patient down the hall who slept all day and yakked all night. Not a whole lot the staff could do about that.

I will have to file that away as a money saving tip. I will ask nurse..."in theory if I were to ask for either Tylenol, Pepto, or NyQuil right now would I be allowed to have it?" If the answer is yes I will self administer from my self administered medical bag and save $185.


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Old 10-31-2014, 03:50 PM   #90
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That makes sense re requested meds but DH never asked for meds, the nurse just brought something random already in a little paper cup and said "time for your meds." I guess he could then have refused whatever the doc had ordered but they would have just been thrown away then I imagine.
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Old 10-31-2014, 03:59 PM   #91
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That makes sense re requested meds but DH never asked for meds, the nurse just brought something random already in a little paper cup and said "time for your meds." I guess he could then have refused whatever the doc had ordered but they would have just been thrown away then I imagine.
And you would probably have been charged for them anyway. It was an offer he could not refuse.

My uncle Guido had a similar operation. Business had to take his protection services and pay for them. Refusal was not an option.
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Old 10-31-2014, 07:45 PM   #92
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I think there was a web based business out there that would negotiate health care bills on your behalf for a small cut. It didn't make sense for me in that I was getting negotiated insurance rates. If I were paying cash, however, this may have been an attractive service. I can't remember the name of it off hand but would probably recognize it if I saw it.

Another useful site is healthcarebluebook.com to get typical negotiated insurance rates for procedures. This was useful in planning my expenses when having my kidney stones treated last year.

-gauss
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Old 10-31-2014, 09:32 PM   #93
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I just saw this today - it has a map of percent uninsured by state before and after the ACA implementation:

http://finance.yahoo.com/news/one-ma...223500256.html
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Old 10-31-2014, 10:22 PM   #94
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I agree the blog owner is partisan, that is annoying, and also the reason I didn't link the site until now. The data is not suspect, unless you can provide another source with similar (scrutinized) breakdowns and sources showing different numbers. It's probably the best overall (and most heavily scrutinized) source of ACA data to be found anywhere - and it does distinguish paid vs not paid. It also carries a monthly count by exchange, so we can see month to month changes by program by state. The data sources are the state exchanges, the state insurance oversight agencies, and many insurers around the country.

We know the 10M Medicaid numbers are net newly insured. There are another 15M qualified health plans (paid). We don't know how many of those are newly insured and probably won't ever know, because health care coverage iwas not subject to reporting requirements. It was all survey.

We still don't know how many people in the US have qualfied health care, because employer plans are also not subject to the same reporting requirement.
Data from state exchanges. It appears the current paid enrollment figures are mainly numbers from unnamed sources and projections from old April data released by HHS that the SS repeatedly links to as support for its "current" state numbers-
http://acasignups.net//sites/default...ent_report.pdf
Updated "data" appear for Paid Exchange QHPs for all states, yet many states (inc mine) have not released official current paid plan enrollment figures since that Apr HHS report. And most private carriers have not reported their data yet (at least not publicly).
A recent blog entry touting KY's low (or even negative) Exchange attrition rate is somewhat typical. As support for this assertion of minimal attrition in KY the blogger offers nothing more than an unnamed "woman I spoke to at the kynect exchange" who reported current paid KY private Exchange enrollments at "80-85k". No spokesman's name or more precise figures are given.
Kentucky: Net attrition? What Net attrition? Current QHP enrollments even or UP since April | ACASignups.net
Among states that have reported updated info, the SS data for CA and CO appear to conflict with latest numbers from official state sources.
For CA- Exchange enrollments as of Oct 16, 2014, the website's SS shows 1.38M vs official CA number of 1.12M.
Covered California Daily News: Individual Market Enrollment Report - October 16, 2014
For CO- The SS figure is 133k vs 114k reported to the press by CO officials.
Colorado Projects 30 Percent Enrollment Attrition | Kaiser Health News
Again- the blog notes these official numbers for CA and CO but the SS does not.
Based upon all of the above, and I could go on, I do indeed consider the SS data as suspect. IMHO- The latest reasonably reliable 50 state data we have are from that April HHS report. If current reliable public data on this WERE presently available, IMHO we would be seeing it from mainstream reporters invested in HC issues. It is a great topic for ongoing coverage. I also suspect that if there were solid data for eight-figures of "newly insured" as this blogger claims, we would be hearing these positive numbers regularly from the WH & in Democratic campaign ads

Re Medicaid- For a variety of reasons, no one yet knows the real number of new 2014 ACA Medicaid enrollees who formerly lacked HI. But I believe the available data suggest the number of Medicaid "net newly insureds" is somewhat less than 10M. HI survey methodology, specifically US Census and those using that template, has changed over the past few years so most HI data are not directly comparable. So calculating net new Medicaid (or private HI) enrollments is not as simple as subtracting "Year 2014 minus Year 2013" survey results. Even the White House acknowledges that. From NYT-
"Tara McGuinness, a White House spokeswoman, said the changes in the questionnaire would “make it easier to measure the impact of the Affordable Care Act because it will be possible to compare data from 2013 and 2014.” But officials said that the data for this year would not ordinarily be available until September 2015, and that the data for 2013 and 2014 would not be directly comparable with the long series of data for prior years."
http://www.nytimes.com/2014/04/16/us...ects.html?_r=0
In addition, people regularly move on and off of the Medicaid rolls. Gross change in enrollment does not equal "net newly insured". A significant minority of those enrolling in Medicaid had previous HI from another source. And subsidized Exchange plans may increase that number. For example, the Berkley work (referenced previously) suggests that just over 20% of CA Exchange (private HI) enrollees will change to MediCal (CA medicaid) within a year.
http://laborcenter.berkeley.edu/pdf/...enrollment.pdf
One of the few 'pure' (consistent methodology) pre-vs post-ACA HI surveys is the Urban Institute's ongoing Health Reform Monitoring Survey, June 14 vs Sep '13 data. It found that the total number of uninsured adults dropped by 8M after completion of ACA's OE period.
QuickTake: Number of Uninsured Adults Continues to Fall under the ACA: Down by 8.0 Million in June 2014.
Other surveys have found that ACA has NOT decreased the uninsurance rate among children, which was already much lower than for adults.
Obamacare Has Not Cut Uninsured Rate For Kids | Kaiser Health News
For there to be 10M net newly insured under Medicaid, these population surveys would all need to be grossly inaccurate and/or the number with private insurance (all indiv, Exchange, + group HI) would need to have DEcreased rather than increased as most data indicate.

We all agree that total HI coverage has increased in 2014, an increase likely in the millions. For my 2 cents, I think the total number of folks with new STABLE (not intermittent) HI is likely in the 6.5-9M range.
Most experts (from all political perspectives) seem to agree that we are some months from reasonably precise figures on where the post-ACA "steady state" HI situation will settle out. And that is barring legislative/admin 'tweaks' to the law.
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Old 10-31-2014, 10:37 PM   #95
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Another useful site is healthcarebluebook.com to get typical negotiated insurance rates for procedures. This was useful in planning my expenses when having my kidney stones treated last year.

-gauss
Some major HI insurance companies (Anthem, Aetna, CIGNA, others) also have pricing info (often web-based service) for some common test/procedures with their in-network providers. After all, usually cheaper for you is cheaper for them too. Unfortunately, info may not be available for all local facilities and sometimes the facility's fee quote (even for same exact service (CPT) codes) is not honored after the service is rendered
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Old 11-01-2014, 04:00 AM   #96
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I would agree that the rack rates are ridiculous and should be abolished.
And that's the crux of the issue: Practically no one really supports any mechanism for doing what you're implying here. We all support bringing about the impact, but there isn't support for any of the mechanisms that would be necessary to bring that impact about, i.e., effectively turning healthcare workers into slaves, effectively nationalizing healthcare providers, effectively banning profit-making healthcare industries, etc.
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Old 11-01-2014, 08:17 AM   #97
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And that's the crux of the issue: Practically no one really supports any mechanism for doing what you're implying here. We all support bringing about the impact, but there isn't support for any of the mechanisms that would be necessary to bring that impact about, i.e., effectively turning healthcare workers into slaves, effectively nationalizing healthcare providers, effectively banning profit-making healthcare industries, etc.
Thou doth protest too much. IMO rack rates are not really much of an issue since nobody really pays the rack rates. Besides, there are emerging tools where one can compare prices and that functionality will only get better over time.

Banning profit making healthcare? Nationalizing health care providers? Do you drive finish nails with a sledge hammer? I guess it is a good idea if you want to stifle innovation.
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Old 11-01-2014, 08:57 AM   #98
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........We all support bringing about the impact, but there isn't support for any of the mechanisms that would be necessary to bring that impact about, i.e., effectively turning healthcare workers into slaves, effectively nationalizing healthcare providers, effectively banning profit-making healthcare industries, etc.
I don't get it. How does publishing a price for services generate slave healthcare workers? It seems like every other business in the country operates on transparent pricing and I'm not aware of anyone enslaved, though I'm not particularly anxious to work at Walmart.
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Old 11-01-2014, 09:11 AM   #99
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Common knowledge around here. The difference between paying the first bill right when it arrives vs waiting a few months and then pay the 'adjusted' price can amount to the price of a new car.

No one I know pays the bill right away. Of course, they won't complain if you

Just last week DW got a small bill ($48) from a procedure in April. She called and they said: "oh, forget about it; the insurance just paid it"

Not sure if this was common knowledge as I always paid my portion of the bill without negotiation because I did not know what to negotiate other than to say " I believe this bill is too high and I'm not paying it" and risk my account going to collection which may affect my credit rating and being denied services by the provider.

Count me in the single payer system camp
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Old 11-01-2014, 09:17 AM   #100
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I think the debate is really a distinction without a difference as we all agree the system is wrong and too expensive. All I know is if it happens to me with crazy pricing and out of network charges slapped on me despite my due diligence there will be challenges, negotiations, stalling, "take to it collections, I don't ever need credit again anyways", "$5 a month payment for life, etc.....Isn't this how a normal medical payment system is supposed to operate?


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I wonder what would happen to one's credit rating if there were some late / unpaid medical bills. My car insurance uses my credit rating among other things to determine my rate.

Recently I was considering simply not paying for a $75 medical bill I received. Fortunately, when I called the provider, they said it was their mistake, and to not pay it.

But it seems the ""take to it collections, I don't ever need credit again anyways" tactic may be what many of us will be forced to use against the "gotchas" that are so prevalent in healthcare billing.
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