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Related: Editorials & Other Articles, Issue Forums, Alliance Forums, Region ForumsWhy Americans Are Drowning in Medical Debt
http://www.theatlantic.com/health/archive/2014/10/why-americans-are-drowning-in-medical-debt/381163/After his recent herniated-disk surgery, Peter Drier was ready for the $56,000 hospital charge, the $4,300 anesthesiologist bill, and the $133,000 fee for orthopedist. All were either in-network under his insurance or had been previously negotiated. But as Elisabeth Rosenthal recently explained in her great New York Times piece, he wasn't quite prepared for a $117,000 bill from an assistant surgeon"an out-of-network doctor that the hospital tacked on at the last minute.
It's practices like these that contribute to Americans' widespread medical-debt woes. Roughly 40 percent of Americans owe collectors money for times they were sick. U.S. adults are likelier than those in other developed countries to struggle to pay their medical bills or to forgo care because of cost.
California patients paid more than $291,000 for the procedure, while those in Arkansas paid just $5,400.
Earlier this year, the financial-advice company NerdWallet found that medical bankruptcy is the number-one cause of personal bankruptcy in the U.S. With a new report out today, the company dug into how, exactly, medical treatment leaves so many Americans broke.
Americans pay three times more for medical debt than they do for bank and credit-card debt combined, the report found. Nearly a fifth of us will hear from medical-debt collectors this year, and they'll gather $21 billion from us, collectively.
Le Taz Hot
(22,271 posts)as we've been told time and again, the ACA makes all of our medical woes disappear. Except when they don't. There are MILLIONS falling through the cracks but too many of the BOG want to deny or ignore that fact. We can't even talk about it without being called "haters."
spooky3
(35,914 posts)On medical bankruptcies, because the provisions are still being phased in.
Le Taz Hot
(22,271 posts)there are other HUGE problems with the ACA that can't be debated on DU without people accusing you of hating Obama. It's too bad because we need open, HONEST discussions in order to work to remedy those problems.
spooky3
(35,914 posts)NYC_SKP
(68,644 posts)Now I had to fight them over a LOT of shit charges and am still fighting them over a $27,500 helicopter ride.
But this isn't new, this isn't ACA's fault.
Fair to say, ACA didn't exactly fix it but CoveredCalifornia was very helpful in my fighting with Athem Blue Cross to get my out of pocket down to what I was told it would be.
Most people wouldn't have known what to do.
I had an aneurism and brain surgery, then an infection and rehospitalization in May and June this year.
Much better now, but still having to fight.
Le Taz Hot
(22,271 posts)And those are the ONLY kind of stories that can be discussed on DU. If you have a different story, you're labeled an "Obama hater."
Doctor_J
(36,392 posts)The law deliberately left the insurance companies in the game. You should not have to fight to get your healthcare.
Good God, get over your crush on the president and start thinking for yourself.
cynzke
(1,254 posts)that REGULATES insurance companies. Thats what its does. If you left out insurance companies it would be single-payer. ACA was passed to "FURTHER" regulate insurance companies not get rid of them. No one in Congress was willing to go for single-payer health care. Instead they chose to pass a law that leaves insurance companies in place but add some consumer protections.
HereSince1628
(36,063 posts)isn't particularly reassuring.
How/where does the ACA allow coverage that does not include hospitalization?
Xithras
(16,191 posts)The HHS requires employers who self-insure to offer plans that meet a "minimum value" threshold, and provides tools that allow them to tailor plans that just barely meet that minimum. As it turns out, if they offer a policy with very low deductibles, low copays, and a few other "optional" coverage's, they can meet the requirements WITHOUT offering hospitalization coverage...which tends to be the most expensive insurance feature for employers. Insurance companies are now starting to offer employers what they call "Minimum Value Plans" which just meet the bare minimums under the ACA and don't offer hospitalization coverage.
The real bonus for employers is that it can often cost absolutely nothing. Because the ACA simply requires that plans not exceed 9.5% of an employees wages, and because most of these minimum value plans only cost a couple hundred dollars a month, the employer can often pass on 100% of the healthcare cost to the employee. The only costs to the employer lay in the administrative overhead to manage the whole thing.
The employer satisfies the letter of the law, and the employee is stuck spending hundreds of dollars a month on shit insurance that won't offer a bit of help. Even worse, because the employer offers a legally compliant plan, the employees are also unable to buy better insurance on the exchange.
The ACA is what you get when you let insurance industry hacks drive health reform. Nobody should be surprised to find these kinds of loopholes.
progressoid
(50,638 posts)Because any day now, the for-profit medical corporations are going to let politicians pass medicare for all.
Any day now.
raouldukelives
(5,178 posts)They will use the money made from gouging people facing pain and death to achieve single payer. And if they don't, well, at least you get a little taste of the blood money.
ballyhoo
(2,060 posts)of men in a secret room.
yeoman6987
(14,449 posts)I am not sure I believe any of these stories. I think they are made up by Republicans to bash ACA. I know of nobody who is suffering under ACA. These stories are lies. Don't fall for them.
Le Taz Hot
(22,271 posts)What is it that you don't believe?
cynzke
(1,254 posts)And this is not new. It happened prior to the passage of ACA and will continue because ACA regulates insurance NOT hospitals/health care. The hospital/surgeon makes decisions on who will perform procedures. The insurance companies set up their networks of health care providers, but neither the insurance companies nor ACA have control over the hospital. If a doctor or surgeon is called in for a consultation or procedure, the insurance company can deny covering the fee if that doctor is not in their network. The bill goes directly to the patient to pay. So, there is a gap between the ACA law and laws that regulate hospitals. Should ACA be amended requiring insurance companies to cover ALL fees including those from outside their networks if medically necessary or should (state) laws that regulate hospitals require them to co-ordinate their procedures with the patient's insurance plan and use only doctors, surgeons, etc. in the insurance company approved networks? It is a gap that existed before ACA and still does, despite ACA. But consider this practice by the doctor calling in a colleague to help perform surgery. Is it really required or are they just helping boost each others income? You scratch my back and I'll scratch yours, wink, wink! Seems to me this is ripe for abuse.
pipoman
(16,038 posts)Medical care. The lowest price charged for a given procedure should be the maximum charged to any self pay patient. Why should Blue Cross pay $90 for a $600 bill, and a self payor have to pay the $600? It should be criminal.
napi21
(45,806 posts)I know because it was offered to me! I didn't even ask, he offered.
Skittles
(157,924 posts)AlbertCat
(17,505 posts)ALL insurance is legalized extortion. Insurance companies should be non=profit.
And the ACA is not health care reform.... it is health care insurance reform.
littlemissmartypants
(24,926 posts)raven mad
(4,940 posts)I had to be medevaced to Anchorage as our local hospital and doctors had no clue what was wrong. The bill for the plane flight was $12,000. One way, less than 400 miles. The expertise of the medical professionals on board was not at all in question; they were great.
My insurance covered $158.90.
We filed for bankruptcy a year later; husband had a heart attack (yes, medevaced again), plus my ongoing care.
LibDemAlways
(15,139 posts)recently took a $2800.00 ambuance ride of less than 20 miles. I am currently paying it down slowly as my relative cannot afford it.
ACA means very litte as long as insurance companies get away with paying as little as possible and continuing to stick the consumer with big bills.
cynzke
(1,254 posts)What a phoney racket insurance is. You have this great piece of paper, then when you incur serious medical expenses, you discover that insurance policy is like trying to cover yourself in a hurricane with a paper napkin.
AlbertCat
(17,505 posts)I understand why health care is so expensive..... new complex technologies that have to run by many high trained skilled professionals. I get that.
But... por ejemplo: I burned myself and had to be run to the Medac on the corner. The whole thing cost like $700 or so. Of course the Ins. company would not pay a dime. I've been paying in for years....hundreds of thousands of dollars! They should have just given me $700 no questions asked!!!
LongTomH
(8,636 posts)I'm tempted to say that ACA 'is a start;' but, the fact is, we need to start all over again!
I'm not cynical about the possibilities of seeing single payer in the US; but, it's going to take time, and we need to address the issue of money in politics, really address it.
840high
(17,196 posts)mrdmk
(2,943 posts)It is a hedge-fund!!!
There, I said it...
cynzke
(1,254 posts)Why there is so much confusion and subsequent argument. ACA regulates health insurance. It added a layer of MINIMUM consumer protections to health insurance plans. HEALTH INSURANCE, not health care. But agree totally about legalized extortion. Do insurance companies actually give you health care? No! They are there to pay your bills for you with the money you gave them. Instead, they do everything in their power to deny or delay your access to any health care that cuts into their profits. WE DON'T NEED insurance companies. They only provide one thing....A TOLL BOOTH. Its disgraceful that Congress left these vultures in place.
AlbertCat
(17,505 posts)Indeed. They just crunch numbers.
Conservatives were so worried about the elimination of health insurance companies and it's effect on the economy if single payer was implemented.
Bah! Those insurance companies can just crunch numbers for something else.... it doesn't matter what. They needn't go under or shed employees.
I remember getting some flyer for insurance to supplement your health insurance if the bill was too high and they weren't paying...
Yes... Insurance insurance!!!
seabeckind
(1,957 posts)Every industry that has consumers.
Every consumer, whether that's a commoner or another supplier.
Anecdote (plural of that is data): Periodically I need a diagnostic blood test. The procedure is that I should know when that is necessary but oftentimes the doctor tells me it's time (heh, heh).
The doctor writes an order (bills the insurance company, I get a copay).
The blood test is in the doctor's office with a subcontractor. Draw (bills the insurance company, I get a copay).
The test is done using a machine and it spits out the result and sub reads it. (bills the insurance company, I get a copay).
Sub sends a copy to the doctor. Doctor looks at it (bills the insurance company, I get a copay).
Doctor's staff updates my records, posts an entry on my record, tells me to look at it.
End of billing except for kickbacks to medical records industry. Krugman had a column a while back about that scam.
Long ago (15 years) the test (A1C) was done in the office with a thumb prick and shoved in the reader. Even the local drug store did it. Now it's a full draw, 2 vials.
brer cat
(26,018 posts)My annual blood test is done while I see my PA for a checkup so there is one co-pay for the checkup, nothing extra for the draw, nothing billed for an "order". The blood is sent out to a lab so there is an additional charge for the lab. The results are sent to my PA who gives me a phone call to tell me everything is ok, no charge for that. I have in the past seen doctors with the same procedure. You either need a new doctor or need to discuss the billing with him/her. That is pretty outrageous, and your experience is good anecdotal evidence of why some medical bills are ridiculously high.
seabeckind
(1,957 posts)While there are some independent doctors, most belong to a consortium, a health "network". In effect the doctors are employees of the network. The network controls most access to healthcare, including rehab facities, etc. They have bought out the community hospitals.
That wasn't true where I used to live but the Franciscan health group was trying to move in and take over the local independent hospital and buy out the small doctor group.
As I said, this maximizing of profits thru procedures is across industries. When I moved across country using United, the company divested the drivers and they are considered independent contractors, hire their own loaders, then bill the company. In effect, their procedures increase the cost to the customer and squeeze the "employees" and then they rake off the profit.
A true competitive model would correct this but there is no competition. In the case of the health networks, they all work exactly the same. Instead of fighting among themselves for pieces of the cow, they decided that each would get half. The competitor has to be satisfied with the part that falls off.
drray23
(7,876 posts)I have the same experience you have. I just pay one copay for the checkup whether or not there is blood work.
The doctor also does not charge me to look at it and tell me if everything is good or not.
cynzke
(1,254 posts)I expect my husband to live to be 300 with all the treatment he gets. He is a regular human guinea pig for Kaiser. It is to the point of ridiculousness. They have him coming in two to three times a month for different procedures and while it is suppose to be for wellness/maintenance, you know they are milking the system for profit. Just mention one little ache or pain and they will line you up for ex-rays, blood work, bone density tests, you name it, they will order it. Give them an inch and Kaiser will find a procedure for it.
marym625
(17,997 posts)I just love your posts. I would say more but I am too tired to deal with the people who live blindly to some things.
deafskeptic
(463 posts)It has a 20% deductible under plan b. For example, a diabetic with some fairly serious complications could end up in an extended stay in the hospital and rehabilitative services and and up with a 100,000 bill with 80% covered under part B. However, you will have to co pay 20k. That's difficult for low income people.
brer cat
(26,018 posts)but I would add that even "middle" income people have problems with that. 20k is a lot to pay.
redstatebluegirl
(12,454 posts)I was never told there would be three surgeons in the room during my back surgery until the bill came. My insurance refused to pay the third one, I argued for months and months. I had to pay it while I argued so my credit wasn't ruined. I finally won the battle, I think I wore them down after a while. I kept everything so I had all of the documents I had signed. It was $12,000, a lot of money to us.
They do this to increase the income in these large medical practices. All three of the surgeons were from the same practice.
We can't fix the cost of medical care until we address things like this.
yeoman6987
(14,449 posts)Did you pay monthly? 12K is a lot of money.
redstatebluegirl
(12,454 posts)After the doctor agreed i had not approved this extra doctor. They refunded the insurance company too. It yook over a year total. We used two credit cards to pay it initially.
vanlassie
(5,894 posts)and getting experience on your/our dime. I saw this when I worked for a major health insurance company. Many second assistant surgeons were subsequently denied, but I'm sure they billed just in case they could score a payment from someone.
cynzke
(1,254 posts)are these assistants REALLY needed in all cases or are some of these doctors abusing the situation, taking advantage to increase their income? Are they mutually helping a colleague, returning a favor to pad their wallets....I call you in to assist, you call me in......we make extra money and either the insurance company or the patient get the check! I think this may be the case in many circumstances.
progressoid
(50,638 posts)But with more mortgage debt.
bigwillq
(72,790 posts)K and R
ACA has done nothing to eliminate issues like this. It's a very flawed law.
littlemissmartypants
(24,926 posts)It is just a matter of time before the commercial insurance companies decipher it and hatch the plan to exploit it's flaws in every way possible. I saw this cannibalistic behavior when BBA and PPS was rolled out during the Clinton administration.
Hospital staff members were sent to seminars to learn how to use CPT codes, with combined ICD codes, to maximize profits when billing payments.
Until we control for cost and bill for patient care and NOT for profit, the system remains deeply flawed.
I am hugely disappointed with ACA. It's like a band-aid on a gaping bleeding wound, as far as I am concerned.
Love, Peace and the Righteous Fight.
~ littlemissmartypants 🙇
bigwillq
(72,790 posts)is the way to go.
Enthusiast
(50,983 posts)We have got to transition to a non-profit single payer system.
We must ask our Democratic candidates and office holders, "Ultimately, do you favor transitioning to a not for profit single payer system?"
If they do not favor this we should know which ones do not and why. We already know they have no good answers if they favor the status quo.
seabeckind
(1,957 posts)unless the oversight would include insistence on savings procedures.
In my anecdotal above I have no idea whether Medicare would have an effect on the billing procedures. I doubt if it would cause each step in the process can justify itself. It's only when you take the 30,000 foot view that the extra costs become glaring.
Or you're the one who gets the bill. And in that case you're just the meat being divided.
I think the solution is a true competitive model. Force the consortium to compete. Use anti-trust to prevent them from becoming too large. Squeeze the doctor to make him reduce his cost to the consumer.
Enthusiast
(50,983 posts)advantage over the US profit driven system. And they are all more effective at Health Care.
The only way it isn't an enormous improvement over the US status quo is if we give the insurance industry a hand in crafting it.
KansDem
(28,498 posts)For this one gig?
Nice work if you can get it...
CTyankee
(64,784 posts)but s/he would have to be pretty damned spectacular for that kind of money...
WillowTree
(5,325 posts)I used to work for a medical billing company. When situations arose where one of the patients that we were billing for utilized an "in network" hospital but were being billed for an out-of-network provider that they had no control over, such as a radiologist who reads x-rays from that facility or an anesthesiologist or assistant surgeon (which, by the way, is often necessary, even though the patient never sees this physician or knows anything about her/him until the bill arrives), if the patient contacts the provider and explains the situation, I never saw in instance where the provider did not agree to accept the "in network" payment amount. Occasionally, it was also necessary to contact the insurer and explain the situation to them, but then they always agreed to pay the provider, but at the "in network" schedule amount.
Yes, it can be a hassle and yes, it ought not to be necessary to jump through said hoops, but it could save you a pile of cash, so I thought I'd throw that out there on the off chance it might help someone here out.
Egnever
(21,506 posts)CrispyQ
(37,975 posts)But we'll never get that in our everything-for-profit model.
seabeyond
(110,159 posts)of $20. cause someone else, somewhere else did a read. well after the fact. checked, fixed, healed. he glances at an xray supposedly. i did not approve. i am damn tired of it. paid one after 2 yrs. have one or two sittin to be paid. and you know. i really really do not want to give this ass 20 for nothing. i really really resent the fuck out of it.
thanks for this article. i read it early. and i have been thinking about this since. appreciate.
WillowTree
(5,325 posts).......of having an x-ray taken if no doctor read it?
seabeyond
(110,159 posts)does what she needs to do. then, a month later, i get a bill for a second opinion. fuck that. the incident well over. and this man in another city, an hour away is supposedly looking at the same xray. no.
WillowTree
(5,325 posts)It used to be that, in many instances, the bill from the hospital or radiology lab that took the x-ray would include the fee for the radiologist, who would be reimbused by the facility. Medicare, however, insists that the facility fee (for the room, equipment and technician who takes the x-ray) be billed separately from the radiologist's fee. That's why you're seeing a separate bill now.
The issue of "another city, an hour away" could be a matter of the images being forwarded digitally to the radiologist with whom the facility contracts (making distance irrelevant), or, more likely, the remote address is that of the billing company which provides billing and collections for the radiologist, who may or may not be local.
But if you're committed to believing that the radiologist is billing when s/he has provided no integral service, have at it. Doesn't change the facts.
seabeyond
(110,159 posts)No Vested Interest
(5,191 posts)transmitted digitally.
Certainly, they are paid less than radiologists in the US.
I would imagine they are contracted by US firms, billed by US firms, and the patient would be none the wiser.
Anyone have experience or solid information re out-sourcing of X-ray interpretations?
Initech
(101,542 posts)That's 149 years of progress since the Civil War. Well done Republicans!
uppityperson
(115,773 posts)Yes, I went into debt to pay those premiums. Another year and I should have them paid off. I am very happy to have the insurance under the ACA that I have so I do not have to go further into debt playing the health care insurance gambling game.
FiveGoodMen
(20,018 posts)There are lots of important details about HOW it works, but that's WHY.
Dirty Socialist
(3,252 posts)Medical profiteers are as bad as war profiteers.
GummyBearz
(2,931 posts)On top of this (which makes me sick to my stomach) is the fact that I was a lucky person, who had great insurance before ACA, and the ACA actually degraded the insurance offered to me, as well as increased my bill for the crappier insurance. The system (meaning big insurance) is so damn wretched at every turn of the corner.
I do applaud a few things, like coverage for an existing health problem, but I expected better than a compromise between something "normal" and something "absolutely evil".
ballyhoo
(2,060 posts)hit next year. I hope to God (is that expression still permissible?) that folks like you will be afforded some kind of relief next year. There is something going on in California right now that may be commensurate to a 3rd party compromise to ACA and former insurances people held, but I haven't DDed yet so I won't say more. Good luck to you.
KamaAina
(78,249 posts)Louisiana1976
(3,962 posts)pnwmom
(109,445 posts)would be out of network -- and that should be changed, by law. In fact, there are two states that require every facility and its physicians to be in-network. (I think Maryland is one and don't recall the other.) We should adopt the same law.
In the meantime, when my son had to choose an insurance policy, I told him to choose the one with his doctor that had the best out of network coverage. There was one that had a $12,000 limit on out of network (as opposed to no limit for the others), so that's what he went with. So he might be better covered than we are, with our group insurance.
Gormy Cuss
(30,884 posts)No one in an ER should be out-of-network if the hospital is in-network, period. A patient in crisis shouldn't have to worry about random big ticket out-of-pocket expenses.
Managed care networks need to go away. It's an idea that doesn't work anymore. The old indemnity plans were better than this.
pnwmom
(109,445 posts)I'm going to add something to the contract. "In-network providers only; and out-of-network providers with my specific authorization."
Can't hurt.
99th_Monkey
(19,326 posts)two things that most civilized nations provide FOR FUCKING FREE (or nearly so) to their citizens.
woo me with science
(32,139 posts)liberalhistorian
(20,844 posts)Something is going to have to be done about student loan debt, the same as medical debt. We simply cannot continue effectively as a nation with our people weighted down with trillions of dollars of student debt. Period. Curse everyone who lobbied for and voted for that damn bankruptcy "deform" bill that changed the law from allowing student loans to be discharged to NEVER allowing them to be discharged. BAH.
liberalhistorian
(20,844 posts)mess is that FICO no longer includes or considers medical debt when calculating credit scores, something I've advocated for many years. It doesn't mean you don't still owe it or the medical debt collectrolls can't still harass you for payment for it, but you no longer have to worry about your credit being ruined if you get sick or injured and can't pay the bills. And I still can't believe there were people here who thought this was just a terrible thing, and people should continue to be financially ruined and punished for the "crime of getting sick or injured, when this was first announced a few months ago.
LAGC
(5,330 posts)I thought I read somewhere that it just wasn't given as much weight (insofar as FICO calculations go) anymore, but still shows up on your credit report which future lenders can see.
Does medical debt ever even drop off your record after 7 years like defaulted credit card debt does? I only ask because I honestly don't know.
liberalhistorian
(20,844 posts)FFICO does not give it any weight in calculating credit scores, which is a huge step in the right direction. In many places, credit scores matter more than what is on your report. That is not to say that some lenders/landlords/employers/insurance companies and others whose money props up the fraudulent private credit reporting and scoring industry do not give the medical debt a lot of weight, but, frankly, many don't as they recognize that it is not a measure of your financial responsibility and reliability as much as, say, not paying rent or running up and then not paying credit card bills, etc.
It doesn't mean you're not still responsible for the debt and that you cannot be pursued for it. And yes, all debts fall off the credit report after seven years, unless a collectroll agency has "re-aged" it, which is illegal. The only exceptions to the seven-year-rule are bankruptcies, which stay on the report for ten years, and court judgments, which can be renewed several times if left unpaid. The Fair Credit Reporting Act and the Fair Debt Collection Act gives this information in more detail.
Personally, I don't believe medical debt should be permitted on credit reports AT ALL, period, not as long as we have a for-profit, insurance-driven health care system. But you've got to start somewhere, and the FICO announcement is a step in the right direction.
flamingdem
(39,840 posts)That sounds like a fuckup and they'll have to pay for it.
I wouldn't throw ACA out with the bathwater.
This example seems hinkey