Number two for sure. You are almost guaranteed to be seen by an out-of-network provider. It does not matter if you go to an in-network hospital/ER, the providers go out of their way to work a couple hundred miles from home just to bring in the big OON prices. Out of three visits to in-network ERs (in two different states) in the last seven years, how many do you think resulted in crazy charges from OON providers? If you said anything other than all of them you must not be from the states. It is basically impossible not to get fleeced by "health care" in the US.
I’ve been to the ER twice in the last 2 years. Once at the hospital blocks from my house & once while traveling for work 800 miles away. In neither case did I get charged out of network charges.
In fact in the 25 years I’ve paid for mine or my families health care I’ve never seen what you describe over lots of ER visits.
There are lots of things wrong with the US health system, providers systematically trying to get out of network fees isn’t one of them.
Not what kasey_junk said at all. It was responding to someone who said:
> It is basically impossible not to get fleeced by "health care" in the US.
The experience is evidence against this very strong statement. You have uncharitably decided it was making an equally strong statement in the opposite direction.
What’s with the ‘out-of-network’ thing that gets pulled out regularly? Is healthcare really that much more expensive to an insurer if it’s done at one site or another? Sure, they’d prefer it was done in-house so that the ticket can be clipped multiple times, but it’s clearly just made up numbers that are produced currently.
It's not that it's more expensive at one place or another for the most part. When you go in-network you are seeing providers that your insurance has a contract with. This contract includes agreed amounts for procedures. Providers will often grossly overbill (mostly because it's easier to let the billing backend resolve these limits than bill accurately in the first place) and your insurance will respond with the amount covered. The remaining amount of the bill is written off because it was in-network so the provider is not allowed (by the contract with your insurance) to bill the balance not covered to the patient.
Out-of-network does not have this protection. Your insurance will possibly cover some of the bill, normally up to some percentage of what they consider a normal amount for the procedure in the area, and then you will be billed for the entire balance. Say your provider bills $100k and your insurance says they think that procedure normally only costs $50k and you have 80% out of network coverage. You would be billed for 20% of the $50k covered as coinsurance, plus the remaining $50k that would've been written off if you were in-network.
This is generally how people get surprise bills.
For a real world example: last year my insurance got billed ~$3k for a routine blood test for my wife as part of an annual checkup. It was in-network and the insurance paid $27 and the provider wrote off the rest.
I understand this, but don’t understand why millions of people are ok with the system. It has a lot more in common with a protection racket than with patient care in my view.
It's not that millions of people are "OK" with it, but that in practice democratic elections aren't actually about policy. Suppose Alice's policy is to do X, and Bob's policy is to do Y, we might suppose voters who overwhelmingly want X will go vote for Alice, but nope, the Bob voters will still vote Bob and then be annoyed that Y happened, independent of continuing to support Bob. That doesn't make sense, but it's what happens.
This would be a grave defect if the purpose of democracy was to achieve good government, but in fact we haven't the faintest idea how to get good government, democracy is a fix for bloodshed during the inevitable power transitions. So, a bunch of idiots with no clue are still in charge, but now a _different_ bunch of idiots can take over without having to murder a bunch of people to do it.
Not true, because people actually hate insurance companies. The best propaganda is by the hospitals because no one ever seems to complain much about them.
There's been a lot of revealing reporting over the past decade but people don't seem to care: the price of a procedure in two different hospitals in the same city can vary by 10x because they literally pull prices they charge from their asses. They tend to justify this by saying "no one ever pays that price".
But when I got a bill for my wife's surgery that included 15k for 1 hour in a recovery room, another 25k for 1 hour in a surgery room, and 9k for an overnight stay (on top of the 20k from the surgeon, 3k from the anesthesiologist, and 3-5k from random doctors we saw for a few seconds) those words sure as shit were not reassuring.
All my past attempts to get an idea of what something might cost me, even when I knew insurance wouldn't cover it, have failed. It takes days worth of time on the phone only to get the wrong answer. One even told me that I only get the cash price if I don't have insurance even if my insurance won't cover it - and I must have insurance because its illegal to not have insurance so I can't get the cash price. What the fuck man?
Hospitals can fuck off. I have no idea why they don't get more blame in this mess.
I think it's something in the American mindset. It's been said before, but Americans think of themselves as "temporarily embarrassed millionaires" when voting (hence why they consistently vote in the interests of the rich - everyone thinks they'll benefit from those tax cuts when they win the lottery/sell their startup/etc).
Same situation here; "health care costs are for those sick losers. I'm not going to get sick, so it doesn't matter to me how much it costs, and I don't want to pay more tax to reduce healthcare costs for those losers".
I exaggerate, but it does seem like there's something like this going on...
I agree with you in part, but in my opinion propaganda and lobbying are the problem because this is the source of the disconnect. When people got increased protections from the ACA, nobody complained. The insurance and hospitals deliberately shitcanned the healthcare marketplace and MOST pepole don't put much thought into why the mandated insurance became unconscionably expensinve, they just thought "Obamacare is worhtless" because that's what they were told.
I don't think it's specifically an American thing to avoid much thought about becoming really ill. It's an uncomfortable subject.
It is partly a cultural thing - a kind of cult of narcissism.
But those attitudes are carefully cultivated by the media. They don't just happen.
Congress and the Senate are full of corrupt leeches, and both parties are equally guilty.
Votes make no difference. Corporate money buys political careers, and it pays for both sides.
There are a few exceptions, cultivated to maintain the appearance of representative democracy, but they're rarely - if ever - allowed anywhere near policy.
Those aren't the equivalencies I'm asserting. My position is that members of both parties expend far too much energy working on re-election fundraising versus working for the people. That's the equivalency I'm asserting.
I don't think millions of people are okay with it. I think the vast majority are unaware, those who are aware have no agency, and very powerful interests seek to maintain the status quo.
yeah. Can you refuse treatment from an OON provider in a hospital? Because that would be my first question if approached by a doctor who could potentially bill me $100K
For ER agreed. For anything else that is serious / non trivial, you also want to consider the repuation of the department. Some doctors are world specialist of something, or treat dozens of a particular condition every year. Others rarely do or are simply not good. I don't think there is any way for a layman to know. You kind of need to ask relatives in the profession, who can themselves ask around. I have a few doctors as relatives and they systematically check the reputation.
It doesn't make sense, but you have to (as a patient) make sure that the provider you're getting healthcare from is covered by the insurance company's (changeable) list. Its indefensible but it's reality.
I cannot wait for reform and I hope it hits before I get old and need it often.
As an aside, even the billing system is fucked up. When I get a receipt for covered care, it often looks a lot like a bill. This has to be by design. Its bad enough that I just ignore both "receipts" and bills and wait for the collectors to call me. That's how I know which is which.
He may have been attended-to by out-of-network practitioner: https://www.nbcwashington.com/news/local/Out-of-Network-ER-S...