'It's a money game to them':son takes on UnitedHealth over elderly father's care
127 comments
·February 13, 2025tombert
ericmcer
Agreed, good healthcare is a huge part of shackling you to your employer. Every time I think about quitting it gives me pause knowing it means a few risky months until I can get a new job and have coverage again.
Insurance has also skyrocketed the cost of care, I was doing a weekly physio/massage visit and with good health insurance it was a $50 copay. I looked back at what the place was charging my insurance and it was ludicrous. They were billing my insurance $400-600 a week and every little thing they did was getting charged. All the cool like "extras" I thought they were doing for me were becoming $50-200 charges.
I partially tore my achilles last year and most doctors I saw just wanted to check all the boxes so they could send a massive bill to my insurance. I ended up seeing 3 different doctors, a physical therapist and a physiotherapist before I finally found someone who really cared about helping me. It was $2000 out of pocket but he really went all out mapping my recovery and performing all kinds of interventions.
I am scared that universal healthcare would introduce so much bureaucracy that doctors will just process you asap, check off their forms and then shuffle you off. It feels like we are getting further and further from the world where you know your doctor and they can say something like "you only needed a referral, lets just call this $40, see ya in a few months". Now it is someone you may never see again, who has no control over how much you are billed and who has 20 more patients coming in behind you.
tombert
> I am scared that universal healthcare would introduce so much bureaucracy that doctors will just process you asap
I hear this a lot, but that doesn't really seem to be what the data says? There have been a good number of studies comparing American healthcare to more socialized systems, and the outcomes are generally comparable or better in the socialized systems. That doesn't imply that if we just changed to a universal system tomorrow that we would have the same outcomes, every country is different, and it's not necessarily guaranteed that copying Sweden's system would automatically work here.
But I do think that it's also not implied that it would lead to the bureaucratic chop-shop that people are afraid of.
munk-a
A good universal healthcare system wouldn't have these issues but, much with a nod to the ACA, would we manage to accomplish a good system or would that system still be riddled with rent-seeking opportunities to protect the employment and profits that the current players extract?
The US seems to have real problems with regulatory capture (especially with recent political happenings where we're seeing tariffs implemented that specifically hurt competitors to those with influence in government) so I think it's important to not fall into a trap of believing you'd walk away with a wonderful healthcare system even if something like medicare for all happened. The entrenched interests would continue to exact their pounds of flesh unless a real sea change was seen away from the current status quo.
I do hope it happens though, I'm a Canadian and my employment is dependent on your system continuing as an entangled morass but I'd happily be out of a job if it meant more equitable access to care.
s1artibartfast
It always comes down to who you compare. Most of the cited information on outcomes look at averages. US healthcare outcomes are bimodal. It is easy to sell the idea to people with poor coverage distribution. The harder sell is the people in the better distribution worried about taking a step down while carrying the cost for other people.
UtopiaPunk
The bureaucracy of dealing with a patchwork of health-insurances plans, their different payment structures, what care is/isn't covered, in-network or out-of-network etc, etc is a HUGE bureaucratic burdern. Doctors already do what you describe, or are at least pressured to do so. Doubly-so as places are being bought out by health insurance companies (like all those "Optum" clinics, which are owned by United Health Group).
A universal health care insurance plan, like "Medicare For All," would simplify bureaucracy. How many times can you honestly say that a government run program would simplify bureacracy?! Not often! But if we could just start over, a single health insurance plan that works the same for everybody in the country would be a huge burden lifted.
bb88
A bureaucracy results in controlling the payout of money. Once people's paychecks are tied to running or working in a bureaucratic system, it's hard to get rid of them. Mostly because they can show how many requests for cash were denied and the savings they achieved which were passed on to the taxpayer or to the stockholders.
A Fortune 500 company will find it easier to negotiate a good plan with easier money for it's employees typically, but a mom and pop shop doesn't have the negotiation power to make the insurance companies pay out.
And just because it's a benefit today, doesn't mean DOGE (or whoever next in power) will enshittify it.
ceejayoz
> I am scared that universal healthcare would introduce so much bureaucracy that doctors will just process you asap, check off their forms and then shuffle you off.
That wouldn't be a change.
cyberax
> Every time I think about quitting it gives me pause knowing it means a few risky months until I can get a new job and have coverage again.
There's COBRA for that! If you quit your job, you can continue your previous employer's coverage for up to 18 months, but you'll have to pay the premiums yourself.
And it's typically cheaper than what is available on exchanges. You can also get a subsidy for COBRA if you can't pay premiums, but only if you were fired.
> I am scared that universal healthcare would introduce so much bureaucracy that doctors will just process you asap, check off their forms and then shuffle you off.
We have universal healthcare: Medicare and Medicaid.
tombert
> There's COBRA for that! If you quit your job, you can continue your previous employer's coverage for up to 18 months, but you'll have to pay the premiums yourself.
That's not really a consolation if the premiums are really expensive.
> And it's typically cheaper than what is available on exchanges. You can also get a subsidy for COBRA if you can't pay premiums, but only if you were fired.
"Typically" yes, but not always. I mentioned in a sibling thread that when I was fired from a job and was on COBRA, the premiums were almost 4 grand a month.
It was so expensive that I actually started calling up different insurance companies in the NYC area, because the premiums were slightly lower even just paying out of pocket, and luckily I narrowly qualified for a medicaid thing, and it ended up being free through the MetroPlus network [1], so it all worked out, but my point is that COBRA isn't always cheap.
> We have universal healthcare: Medicare and Medicaid.
Medicare and Medicaid are great programs, I'm very glad they exist, I think it would be horrible if they were taken away. That said, they're not "universal" healthcare. It's pretty easy to fall through the gaps where you're "too rich for Medicaid" but "too young for Medicare".
Anecdata, but my brother in law does work for a living, as does his wife, and together they end up making somewhere around $75,000/year in Texas. Not a terrible wage, people have certainly lived on a lot less, but neither of their jobs have health insurance, and they make too much together to get it for free from the state.
[1] If you ever get fired in NYC, I'm sorry to hear that, but do not hesitate to call MetroPlus. The agents there was extremely nice, helpful, and without an ounce of sarcasm I think that their existence makes the world a better place.
howard941
COBRA is not cheaper than exchange plans. Medicaid is not universal; in many places - Florida for ex - it isn't available to most men, to other-than-the-elderly, and other-than-children.
What's this about getting a COBRA subsidy if you're fired? Where did you hear that?
ceejayoz
> If you quit your job, you can continue your previous employer's coverage for up to 18 months, but you'll have to pay the premiums yourself.
With what money?
> We have universal healthcare: Medicare and Medicaid.
Do you know what "universal" means? Both of those programs have significant restrictions on who can access them.
conductr
I think this sums up the problem. People that have suffered by the affordability issue or hit some of the money traps (excessive charges for referrals, needing prescriptions for basic antibiotics and glasses/contacts, etc), seeing how different people pay vastly different prices, and so on. This group is likely to be in favor of universal healthcare.
But there’s a whole other group that hasn’t had that friction yet, are lucky enough to have the “good insurance”, are completely naive, and/or just buying into the lie that this is all normal and what’s best for everyone. This group reads your comment and thinks “you just want me to pay for something because you can’t afford it” which is a very flawed take.
ceejayoz
The "whole other group" also often has no idea how much their healthcare actually costs. I know folks who pay $0 or $50/month, because work picks the rest of it up. They think that's how much health insurance costs.
It can be challenging to get them to believe that it's $3,600/month on the open market in my area for a family of four.
A_D_E_P_T
You don't even need socialized healthcare, really. What you need is a system that doesn't exhibit the insane amount of regulatory capture that's on display in the US.
I lived in Hong Kong for a while. In Hong Kong:
(1) If you want to see a doctor, you just pay cash. Fees are reasonable. (~$50-80 for a GP up to $350-400 for a top specialist.)
(2) There's no other way to pay. (If you have insurance, they might reimburse you later.)
(3) You don't need referrals for anything. (If you need to see a specialist, you call a specialist directly and make an appointment. Many of them will see you on the same day you book an appointment.)
(4) You don't need a prescription for just about anything. (Antibiotics and steroids -- and all the the most powerful non-recreational drugs -- are available OTC.)
(5) ERs, emergency services, and things like childbirth are covered by the government, but the service is generally worse than you'd get if you pay out of pocket.
The US system isn't more "capitalist" -- it's captured by special interests and middlemen to a mind boggling extent. And you don't necessarily need "socialized" healthcare -- you need a system that gives both patients and doctors more agency.
DarmokJalad1701
> And you don't necessarily need "socialized" healthcare -- you need a system that gives both patients and doctors more agency.
You can get something sort of like that here in the US - direct primary care. I pay ~$125 per month to my doctor. This can be paid from an HSA/FSA as well. It is not as expensive as "concierge health care", but you get most of the perks and immediate access.
Appointments are usually available next day or even same day - as many times as I want. No co-pays. The doctor has far fewer patients so you can actually talk to them for an hour or two during your appointment. They can charge insurance (if you have it) for most lab-work or you can pay them reasonable rates out of pocket.
They can refer you to specialists if necessary (who may require insurance), or even consult with specialists with your permission, at no extra cost.
The on-going care/prevention aspect will probably help save money and keep me healthier in the long run as well.
margalabargala
> (4) You don't need a prescription for just about anything. (Antibiotics and steroids -- and all the the most powerful non-recreational drugs -- are available OTC.)
IMO antibiotics and antibiotic resistance are one of the strongest arguments in favor of gating certain medications behind a prescription.
sympil
Universal care is the moral option. Hong Kong was great for you because you had means.
A_D_E_P_T
I mean, sure, that's fair.
But... The amount of money I spent on medical care in Hong Kong, per year, was probably 1/10th of what I'd have to spend on medical insurance alone if I were in the US. Because patients and practitioners have more agency, and because pricing is transparent, there's actual competition in the market.
Sure, you need money, but it's less than you think, and there are fewer hoops to jump through, fewer roadblocks to treatment.
The optimal system is probably something like that. A public system for emergencies, child delivery, and absolutely necessary treatments -- and a transparent, open, private system for everything else.
jt2190
Surprisingly, in the U.S. it’s people with means who can’t afford healthcare. Poor people are covered under various state and charity programs.
tombert
There's probably some truth to that; I think a lot of the medical establishment in the US treats the insurance industry as a glorified "slush fund".
caycep
When I visited, it seemed like there was a good government healthcare system in Hong Kong, and a network of very good public hospitals. Just the private docs are not in that system. I don't know the specifics but I am pretty sure Queen Mary and Pamela Youde Nethersole Hospitals and others were public hospitals.
A_D_E_P_T
Oh yeah, but for routine outpatient stuff the government health system is generally not widely utilized. If you get into an accident or receive a cancer diagnosis, then I know from experience that it's top tier.
buildbot
Someone in my family has macular degradation, it seems like an awful and incredibly hard way to loose your vision slowly over years.
Hopefully your wife's vision is not getting worse too fast, autoimmune sounds bad still, as someone with normal vision. Losing your eyesight is terrifying, in my opinion.
Tying health insurance to your job has to be one of the worst parts of the American system.
davidw
I did some software work, years ago on a 'perimeter' machine that projects points of light at varying intensities so that doctors can track macular degradation.
https://www.icare-world.com/us/products/#perimeters
It was interesting work in terms of the tech, but pretty sad stuff learning to the doctors come in to present information about the pathologies involved.
tombert
It's definitely bad, but fortunately it has responded really well to immune-suppresers, and it's fortunately only one eye. There's definitely some level of permanent damage, she is unlikely to ever get it back to 100%, but it's certainly not as bad as it could be.
> Tying health insurance to your job has to be one of the worst parts of the American system.
Yeah, it gives companies so much more power than they really deserve. Not only can they cut off my income supply, which is more or less the nominal agreement we have as part of the capitalist transaction, but they also get to decide if I (or any of my dependents) get to get treatment for any kind of illness.
The medicaid system in the US is actually not too bad, I was really grateful for that in the tail end of 2023 and beginning of 2024 when I was unemployed, but it's extremely concerning that (SOME UNNAMED POLITICIANS THAT I WON'T NAME BECAUSE I DON'T WANT TO BE FLAGGED BY SOMEONE WHO THINKS THAT BRINGING UP POLITICS IS SOMEHOW OUT OF THE SCOPE OF HN) want to drastically cut that program.
coderatlarge
What about cobra coverage?
xyzzyz
Just for context, here is what it would have looked like in socialized medicine system, the UK’s NHS:
so we went to an ophthalmologist's office, to get it looked at
In UK, you can’t just go to ophthalmologist’s office. You’d first need to schedule an appointment with your GP, who then would (or would not) give you a referral to a specialist. You then need to wait for something between 6-12 months (sometimes more, depending on your location) for an ophthalmologist appointment. You wouldn’t need to pay for it out of pocket, but you’d wish you had an option to pay the damn 500 quid so that you can start the treatment sooner.
tombert
I had to wait almost six months to get her treatment here as well because I couldn't afford it. At least in the UK I wouldn't have been out the cash.
Also, I hear lots of horror stories about wait-times in universal healthcare systems, but that always seems have smuggled in the premise of "you don't have wait times like this in the US", which has certainly not been my experience.
I wanted to see an allergist in 2022, so I went to my health insurance portal, and called a few in the area, and the earliest appointment that I could find was almost four months out. My wife had to wait for months even from our good insurance to get approved for proper medication for her eye problem. What insurance do you have where you're not stuck with long bureaucratic waiting lists?
caycep
I would agree. The irony is the much maligned HMO's now seem to beat PPOs, maybe because at least they have a more structured referral system and predictable rules, vs. PPOs always try and fight you.
Double irony is the govt healthcare programs seem to be paying/performing better than the privates (Medicare is like the perfect PPO and no wait, managed medicaid/medical used to be sloooooow but now seem to be improving as the in-network provider availability is improving)
rbetts
Wait time is a function of supply not insurance regime. And in OPs case, he was still referred. Where I live in the US, dermatologists are in high demand. It can take a year to get a routine appointment. My wife recently had a dermatologist cancel (dr was going on leave). The office provided a list of other dr’s to call for an opening (who may or may not be in our insurance provider network.).
Wait times are not exclusive to social insurance at all and insurance networks only further complicate matching supply and demand.
Aurornis
I remember having this same conversation with a family friend in another country when I was younger. I had read so much on the internet about how American healthcare is bad in every way and EU/UK/Canadian socialized medicine had it all figured out.
The family friend patiently explained all of the things I take for granted in America, such as being able to choose my own specialists, getting a long list of treatments that were very difficult to get approved in their country (ADHD medications, for example), and the ability to shop around for shorter wait times.
Really opened my eyes to the tradeoffs that come with different systems, whereas the Reddits of the world would make you think America is the worst in every dimension and there are no downsides in other countries.
The more I read these conversations, it becomes clear that Americans don't actually want the healthcare systems and rules of other countries. They want most features of American healthcare, but without the pricetag.
There's a lot of room to work on improving how things get paid for, but I worry that anything that involves compromise or tradeoffs is DOA, politically. We want it all, we want it now, and we don't want to have to pay for it.
xyzzyz
I am in complete agreement with you. Fortunately, there is a good way to make solid incremental improvement here, which would be easy to sell to the American public on both sides of the political spectrum: increase supply of medical services. Educate or import more doctors, make it easier to open new practices and hospitals, and reduce overhead required to operate them. Do that, and prices will go down.
hn_acc1
My acquaintance who moved to the US a few years before I did (both from Canada) said it this way: if you have a good job / are wealthy, US healthcare is miles ahead of Canada. If you are poor, it is much, much worse.
tokioyoyo
Counter point, when things are urgent, it gets done for free pretty fast in countries where I lived with such healthcare. Speaking from personal experience.
hn_acc1
Agreed. My parents in Canada both had cancer treatments without delay, they both recovered, etc. With $0 out of pocket. I'd at minimum have to pay the Kaiser max co-pay here for a similar problem.
blibble
you can pay for a same day private GP appointment (~£150)
they can refer in the same way an NHS GP can, and you can normally get a same week appointment
(obviously you pay for it)
xyzzyz
Yes, the free market medicine solves some of the socialized medicine problems.
fzeroracer
> In UK, you can’t just go to ophthalmologist’s office. You’d first need to schedule an appointment with your GP, who then would (or would not) give you a referral to a specialist
I literally cannot see a specialist in the US without a referral or else insurance will deny it. And this is on a good healthcare plan.
> You then need to wait for something between 6-12 months (sometimes more, depending on your location) for an ophthalmologist appointment.
It took me around 2-3 months to see my doctor, and then talking to them it would take another few months to even talk with a sleep clinic.
> You wouldn’t need to pay for it out of pocket, but you’d wish you had an option to pay the damn 500 quid so that you can start the treatment sooner.
I cannot pay out of pocket to start treatment sooner because it would cost an insane amount of money and waste the large amount I pay on health insurance coverage.
cyberax
> You then need to wait for something between 6-12 months (sometimes more, depending on your location) for an ophthalmologist appointment.
I needed a specialty ophthalmologist (for dry eye treatment) and the wait time in Seattle was 4 months. Another time, I needed a cardiologist appointment and the earliest one available within my insurance network's coverage was 5 months away. And I had literally the best insurance plan we could get.
Both appointments were at least several hundred dollars out-of-pocket.
Tadpole9181
I love the silent omission in all these "waiting time" arguments... the majority of America doesn't regularly get healthcare and delays diagnostics and treatment because they can't afford it. So those "wait times" are low because The Poors don't burden the system by actually being taken care of.
jimbob45
Surely price caps are the solution here, no? I don’t want big tickets items like Total Hip Replacements price-capped but referrals certainly are not a high-skilled line item.
KittenInABox
I have complicated feelings about universal healthcare... namely that the issue seems to be more-or-less not whether the system is socialized or private but if the healthcare system is provided adequate funding (via government or a private entity) to give acceptable outcomes on a population level. A lot of the detractors to private healthcare is simply that healthcare isn't being administered appropriately (pressure to only see patients for 15 minutes for example or to charge by procedure encouraging specialists where systemic issues go ignored) but so is the case for socialized medicine (waiting too long for specialists, understaffed hospitals).
beezlebroxxxxxx
Providing a socialized system with adequate funding requires elected officials and voters to have appropriate and matched priorities. Voters, regardless of party in Canada for example, generally all agree that the socialized healthcare system needs more funding and to be a higher priority. I understand that when you remove party affiliation from the prompt a majority of Americans are also generally in favor of socialized healthcare and would like to see it expanded.
Critics of socialized healthcare often point at things like waiting too long for specialists, or understaffed hospitals, presenting them as inherent to socialized medicine itself when it's more often the product of elected officials who simply don't think socialized healthcare deserves adequate funding, or are against the idea of socialized healthcare entirely. Politicians will often piss in your cup and insist to you it's champagne.
There is, of course, the economic arguments around public vs. private health-care systems; but there are also the philosophical, moral, and ethical, arguments regardless of economics. Some things are expensive and yet we still understand they are a good and humane thing to do.
KittenInABox
I'm not saying that socialized systems are inferior to private ones, nor am I attributing things like specialist waitlines to socialized healthcare specifically. I'm pointing out that I think both criticisms to private or socialized healthcare fundamentally are more about how well-administered they are. I don't know if there's been a real analysis about the systems outside of their administrations, in which case both parties for either side can argue "well it's an issue of funding, not the system itself"...
s1artibartfast
> Some things are expensive and yet we still understand they are a good and humane thing to do.
I think this is often a sticking point for agreement. It is hard to get buy in without some level of guardrails on cost and impact. I dont want to bet my house, retirement, and children's future on the promise socialized healthcare will be a net savings for both the public and for me.
For this reason, I think opt-in Medicare is a reasonable middle path, where governments can demonstrate the cost reductions and care, allowing people to voluntarily convert at their own pace.
This would go a long way do dealing with the risk aversion, but I think many people ostensibly for socialized healthcare are too scared test if it could actually compete on price and value.
s1artibartfast
yeah, I think socialized healthcare is seen as a solution without articulating the specific problem, usually affordability.
Surely a $550 copay for referral would still be frustrating if it was charged by the government.
dfxm12
Importantly, it's not just progressives that have takes about why we should have socialized healthcare. Maybe some people are afraid of the S word, but when you ask people about universal healthcare, support cuts across party lines. We especially saw this in the wake of other recent United Healthcare new.
It just goes to show, aside from the few who keep beating the drum about this, Bernie Sanders, etc. this is just another issue that shows how the people in political power aren't there for you or me, they're there for their billionaire friends.
rqtwteye
What i don’t get is that the US system is not only super expensive but also totally clunky. As patient you need to track who is in an out of network, nobody can tell you how much something will cost, provider directories by the insurance are often wrong, hospitals constantly make mistakes, insurance denies valid claims, insurance gives you wrong info, ambulance may 5000 or 0, nobody knows, cash prices may be cheaper than going through insurance . It almost feels like as patient you need to program the system in assembly where you need to know every little detail of the system without any documentation. Nothing makes sense but everything costs a lot of money.
At a minimum there should be regulation (I know it’s a bad word now) to make the system easy to use without costly traps.
booboo12345
What's not to get? This is what privatization does. It's not for proper care of patients, it's for money to flow upwards to a single individual.
Logically and financially, a single payer system makes way more sense. No marketing costs, no CEO costs, no costs for the entire medical billing industry, no costs for excessive paperwork.
Just care.
When my mom was in hospice last year for a month before she passed, Medicare covered that 100%. It was amazing, it's like, didn't have to worry about being bankrupt after she passed. No paperwork for us to deal with, no surprise bills, etc. just care.
Imagine the world...
thephyber
To be fair, there are much better models for privatization (eg. Israel has 4 competing HMOs and the poor are given subsidies by the state).
There are many problems with the US healthcare system, not the least of which is the fact that we have something like 18 different ones.
9rx
> This is what privatization does.
This is what regulatory capture does. It may be so-called "private" but the government still wants to regulate it up the wazoo, in all the wrong ways. This prevents new businesses from making things better.
> a single payer system makes way more sense.
If the single payer is the very same government then it becomes incentivized to bring the regulation in line to something more sensible. Of course, if the single payer is a separate entity that won't necessarily happen. For example: Amish communities in the US often administer a single payer system, but they haven't been able to fix the situation.
Flozzin
I am sure there is a cost savings if insurers were just required to pay. I have to imagine, they put a lot of effort auditing if medical service was in-network/covered by the plan. And more effort in fighting the people over claims. This isn't to say there is not genuine fraud or abuse going on by hospitals/doctors, but you often hear of people just trying to get their treatments covered.
sneak
> This is what privatization does.
Yes, this is the same reason it takes 7 weeks and two referrals to have my car serviced, or my floors cleaned. Private industry is terrible at these things.
vasco
Exactly, this is clearly not a problem of privatization. In The Netherlands for example the system is privatized but highly regulated and there's no such issues. And like you said there's infinite industries without interference from the state where you clearly know prices and can decide what you want and no shenanigans. The US just fucked up the system somehow but privatization isn't the problem.
martinbaun
I don't get it as well, though I think the situation is classical regulatory capture. In other words, the wrong regulation.
I like the style the Czech/German system is doing healthcare. It is public but kinda private. You pay to the government, but you decide where to go so the hospitals/doctors compete for your money. It is very different than the centrally planned Danish or English based where there's basically some person in top that decides everything.
throw9394848
I am Czech. I do not have dentist or GP, they are overloaded, none are taking new patients! I have to pay private treatments out of my own pocket! Alternative is to spend like 30 hours calling and calling, and then wait 3 months for an appointment at dentist!
I am forced to pay about 500 euro on mandatory public health insurance (tax) every month!
ceejayoz
The same is true in my city in the US, though. My dermatologist schedules 6+ months out for new patients; cardiac/neuro is 3-9 months depending on the urgency. Most of the primary care practitioners in the area are full up; I see regular posts on the local subreddit looking for anyone, anyone taking someone.
null
z2
And also where the industry that's supposed to be regulated is reverse-dominating the regulatory agencies. Maybe par for the course in other industries too, but they have powerful lobbying groups like American Hospital Association.
anthonyskipper
It has NOTHING to do with regulatory capture.
The US is polarized with the republicans not wanting any socialized health care because they don't want to care for people not like them. You can't organize and correctly run a health care systems when half you politicians actively sabotage and burn it down.
Supermancho
> not wanting any socialized health care because they don't want to care for people not like them because they don't want to care for people not like them.
Categorically, older individuals tend to vote more conservative and more republican. This doesn't make sense to me at all.
What makes more sense is that they argue against the socialization of any industry that funds their campaigns.
Democrats seem to take a more middle ground. ie Obamacare socialized low cost solutions and pushed costs uphill toward people who need more expensive care.
DontchaKnowit
Do you really think politicians are motivated by "not wanting to care for people not like them"
That's such an insane assumption to make.
unsnap_biceps
> As patient you need to track who is in an out of network
It's not even which facility, but which staff member! My mother had a pair of surgeries at the same facility, but the first anesthesiologist was in network and the second one was out of network. Both worked for the same place, but the second one was a contracted employee and so they bill differently then the direct hired ones.
It was a major mess and ended up costing us an extra 10k or so.
sumtechguy
I am currently fighting a 4k bill. For some super glue and gauze and 'oh it shouldn't be more than 150 that you are paying today'.
They literally just charged me the max they possibly could to my insurance. The insurance just said 'oh well' and paid part of it. Now I am in collections over 1/3rd of the amount I can easily pay.
The provider will not even tell me what procedures got it up to 4k. How the hell did that pass the insurance sniff test.
These jackasses are just sending out bills and hoping someone will pay it. Your credit screwed over. Oh well. They already got paid.
My mother ended up with a collapsed lung. The doctor caused. Then they charged her for it. My mom had a nurse hand my mom her own purse and my mom fished out a bottle Tylenol. 400 bucks.
No one knows what is going on or how things are being charged. At this point it is obviously on poupous. This is not health care. It is racket designed to steal money from people who are sick.
hn_acc1
Seriously. If it wasn't for Kaiser making this somewhat sane (even though maybe their care isn't as good as "the best" specialists), I would probably be a nervous wreck, trying to juggle stuff for my family..
twoodfin
Not helpful to you now, of course, but this billing practice is now illegal:
https://www.cms.gov/nosurprises/ending-surprise-medical-bill...
(Signed by Trump during the 2020 lame duck!)
jallmann
> As patient you need to track who is in an out of network
It's worse than that, there are also "tiers" within a network, even for different physicians under the same health group. We were actually debating moving our kids to a different doc (but in the same office!) because of this.
The whole system is madness.
wil421
Never experienced what you describe. My pediatric practice is the largest in the state and has like 10 doctors and 10 NPs. We can see whoever we want.
Maybe the health care conglomerates in my city are decent but I’ve never ever tried to book any appointment and been told they are out of network. Never had a hospital experience where some random doctor was out of network but everyone else is.
ceejayoz
There's been regulatory action on this in the last few years, but the really insidious scenario here was in-network facilities employing out-of-network staff in ERs and ORs, where several different providers are involved.
https://www.nytimes.com/2022/06/30/well/live/surprise-medica...
> These bills arise because even if you visit an in-network provider, you can still be treated by an out-of-network physician who works there, said Karen Pollitz, the co-director of the Kaiser Family Foundation’s Program on Patient and Consumer Protections. “The doctors who work in hospitals generally don’t work for the hospitals,” she said. “They bill independently, and they can decide which networks they participate in.”
Things like a major operation where the hospital, surgeon, nurses etc. were in-network, but the anesthesiologist - who you may never have even encountered while conscious - was not.
https://www.nytimes.com/2014/09/21/us/drive-by-doctoring-sur...
> In Mr. Drier’s case, the primary surgeon, Dr. Nathaniel L. Tindel, had said he would accept a negotiated fee determined through Mr. Drier’s insurance company, which ended up being about $6,200. (Mr. Drier had to pay $3,000 of that to meet his deductible.) But the assistant, Dr. Harrison T. Mu, was out of network and sent the $117,000 bill.
> Patricia Kaufman’s bills after a recent back operation at a Long Island hospital were rife with such charges, said her husband, Alan, who spent days sorting them out. Two plastic surgeons billed more than $250,000 to sew up the incision, a task done by a resident during previous operations for Ms. Kaufman’s chronic neurological condition.
> “The idea of having an assistant in the O.R. has become an opportunity to make up for surgical fees that have been slashed,” said Dr. Abeel A. Mangi, a professor of cardiac surgery at Yale, who said the practice had become commonplace. “There’s now a whole cadre of people out there who do not have meaningful appointments as attending surgeons, so they do assistant work.” In Mr. Drier’s case, each surgeon billed for each step of the procedure. Dr. Tindel billed $74,000 for removing two disks and an additional $50,000 for placing the hardware that stabilized Mr. Drier’s spine. Dr. Mu billed $67,000 and $50,000 for those tasks. If the surgery had been for a Medicare patient, the assistant would have been permitted to bill only 16 percent of the primary surgeon’s fee. With current Medicare rates, that would have been about $800, less than 1 percent of what Dr. Mu was paid.
thephyber
Data/information asymmetry is a feature.
The side of the transaction who has better visibility+analysis, the more likely they are to win on the transactions.
xadhominemx
“As patient you need to track who is in an out of networK”
I just specify my insurance provider/plan in zocdoc and generates a list of doctors who are in network and their calendar of availability. I think this was a bigger hassle 10 years ago, yes.
cyberax
Oh, a sweet summer child.
That's only for the initial GP visits and maybe for simple tests. Once you get into specialized treatment, it's a whole another world.
For example, if you are admitted to an in-network hospital, an infectious disease specialist can be out-of-network, and you will have to pay for them.
api
The US system combines everything bad about bureaucratic socialized medicine with everything bad about private health care.
dfxm12
Our government largely works for the billionaires who make money off this system. This is a problem. Keep this in the back of your mind until the next primary election you can vote in & tell your current representatives that you want a healthcare system that works for you.
Animats
This is a problem with "Medicare Advantage", which is an HMO scheme. The Government pays the HMO a flat fee per patient, and they try to minimize expenses. Don't take that route. For now, "Traditional Medicare" plus a commercial supplement is a far safer deal.
However, this may change. See [1], p. 465, which proposes to make "Medicare Advantage" the default.
"Medicare Advantage (MA), a system of competing private health plans, is the major alternative to traditional Medicare for America’s large and growing cohort of seniors. The program provides beneficiaries with a wide range of competitive health plan choices—a richer set of benefits than traditional Medicare provides and at a reasonable cost. Equally as important, the MA program has been registering consistently high marks for superior performance in delivering high-quality care. Critical reforms are still needed to strengthen and improve the program for the future. Specifically: 1. Make Medicare Advantage the default enrollment option. ... "
[1] https://static.project2025.org/2025_MandateForLeadership_CHA...
thow16161
I'm stuck in a Kafkaesque situation w/my insurance company (Anthem). I currently get infusions of a biologic for Crohn's. These are incredibly expensive as well as inconvenient. I'm lucky, in that my insurance company pays for almost all of this.
The same drug is now available in the form of a self-administered pen which is far less expensive and more convienient. However, that falls under the purview of CVS Caremark, who Anthem has designated as its pharmacy benefits manager. CVS Caremark is denying the pen, saying I have to try a whole host of other meds which do not work for me first.
I talked to Anthem yesterday, and they have no idea how to get this approved. Their best suggestion is that my doctor schedule a call with the CVS doctor to argue with them. My doctor is not motivated to do this, as I'm already getting a treatment that works for me.
So I'm stuck wasting hours every few weeks for an infusion that could be replaced by an injection I give myself. And the hilarious part is that the insurance company stands to benefit the most, as they would pay far less.
This is the kind of thing that, if we had actual socialized medicine, I might be able to appeal to a government official to fix. But how can you appeal corporate bureaucracy?
BugsJustFindMe
I just want to throw into the thread that a family member who was also getting injections had their Crohn's go into full remission after they started taking low dose naltrexone, which as a pill is both cheap and easy to self-administer even without insurance coverage. Maybe you've already explored in that direction, but if not, N=1 it appears to have been miraculous.
ericmcer
I don't know if the ease and speed at which government officials fix things is a compelling argument for socialized medicine.
bfrankline
Yet people love Medicare and Medicaid.
Henchman21
Send, via registered letter, a request for the following:
- the name, license #, and board-specialty of the physician making this determination
- copies of all materials used to make this determination
- proof the doctor making this determination has maintained registration in your specific state and documents proving they meet all their continuing education requirements
- the aggregate rate at which this specific condition is denied or approved by this specific doctor making your determination
(YMMV, I haven’t had the opportunity to try this, though it comes highly recommended from a physician’s assistant who deals with this bullshit endlessly)
Schiendelman
You are probably best off just not fighting it. Keep getting the infusions. Stop worrying about it. Let the insurance company make a decision if they think they can save money.
BugsJustFindMe
You must have missed the part where the other treatment isn't just cheaper but also notably better for their quality of life. Telling someone to just stop worrying about it is awful.
inkcapmushroom
How I Learned to Stop Worrying and Love the Injections.
bastardoperator
Americans love to talk about freedom and rights, you don't even have the right to die with dignity in this country. Healthcare in America is just a basic racketeering scam at this point.
napoleongl
And how low of a tax they pay compared to SoCiAlIsT countries where the tax also takes care of health related things… It seems deeply ingrained they’d rather pay a 1000 bucks for themselves and not risk helping someone else rather than pay 100 bucks that someone else might also benefit from.
DontchaKnowit
The problem is our government is so unfuckingbelievably irresponsible with money that increasing taxes wouldn't actually move the needle. And our taxes are not really that low. If 30% income tax is low then idk what the fuck to tell you.
chrisbrandow
Side note: Medicare advantage is the worst. If you have an elderly relative, make sure they stay on traditional Medicare.
kstrauser
My wife's a doctor who sees a lot of Medicare patients, and she warns all of them about Medicare Advantage.
Don't do it.
like_any_other
I wonder if reporting on this stuff will also be called "stochastic terrorism".
tejohnso
“They were just cutting him off because they could cut him off and reduce their expense,” Robby Martin said in an interview. “It’s all a money game to them.”
What else would it be to them? They're not a charity. I don't see why people keep directing their hate toward the corporations for doing what they're intended to do. The hate and effort should be directed toward the politicians who prevent the implementation of changes that people want. Or do the majority of people not want changes that would prevent this kind of thing?
thinkingtoilet
No. This is the "just doing my job" defense. If your job is to kill people so you can make a buck, then you are a garbage human and I'm not going to cry if someone hunts you down in the street.
MiddleEndian
If some guys mug me while the cops watch and do nothing, I can be angry at both groups, especially if the guys previously paid off the cops.
Henchman21
I refuse to believe an actual human wrote this. You must be a bot or an LLM or similar. No human could be this obtuse.
ceejayoz
> What else would it be to them? They're not a charity.
I mean, they could be a not-for-profit entity.
> The hate and effort should be directed toward the politicians who prevent the implementation of changes that people want.
Why not both? I can be mad at the companies who are purchasing those politicians, too.
mandmandam
> I don't see why people keep directing their hate toward the corporations...
> The hate and effort should be directed toward the politicians who prevent the implementation of changes that people want.
Who do you think is hiring the lobbyists to pay off the politicians?
Who do you think is paying the media to make sure people don't know that we're actually pretty agreed on this issue?
I have enough anger for 'both' political parties, the corporations that buy them, and the media (social and corporate) that runs cover for both. And I'm not remotely apologetic for that; I believe it's the only rational and humane opinion to have about healthcare in the US.
ChrisArchitect
Related:
Health Insurers Deny 850M Claims a Year. The Few Who Appeal Often Win
https://news.ycombinator.com/item?id=43032224
UnitedHealth Is Sick of Everyone Complaining About Its Claim Denials
svilen_dobrev
wasn't the plot in "Man called Ove" about similar "get the money" schema? And that's Sweden..
bix6
Well duh it’s a private for profit corporation. It literally exists to be a money game.
owisd
The deal private for profit corporations make with society is that profit provides an incentive that leads to better outcomes, yet every developed country with a not-for-profit healthcare system has better outcomes.
bix6
Did UHC explicitly make that deal or are we just expecting them to act in good faith? Healthcare is a quasi public good so I’m not surprised not for profit countries do better.
throwway120385
The question isn't whether this is obviously a result of the current structure, but rather, is this good for the people of the US to live like this? Should we tolerate people being evicted from nursing home programs because their coverage was wrongfully revoked? And when we have story after story of private insurers doing this kind of thing, do we keep living with it to stay in our capitalist utopia, or do we conceive of something different and collectively pay for that instead of for the private insurance we all hate?
bix6
We shouldn’t tolerate it so hopefully these pieces can convince citizens to start forcing better alternatives.
xadhominemx
UNH makes low operating margins. If they they took those margins to zero, there would not be a noticeable increase in the amount of care they fund.
insert generic American progressive take about why we should have socialized healthcare here.
My wife had an issue with her eye that was giving similar symptoms to macular degeneration [1] in 2016. I had insurance (it might have even been UHC, but I'm not 100% sure), so we went to an ophthalmologist's office, to get it looked at.
When we get to the office, we find out that just the copay for this was going to be $550. I was kind of crap at saving money back then, and I had a job that didn't pay great, and I remember I had exactly $578.23 in my bank account at the time, and I still needed to pay my rent. I had to kind of awkwardly tell my wife "sorry, we don't have the money to have your eye looked at and pay our rent", so we leave without her getting any treatment.
About 4-5 months later, I got a better job with much better health insurance, so she went to that same ophthalmologist, and our copay was less than $50. The entirety of the work that this ophthalmologist did was refer her to a retinal specialist.
This means that I was initially going to have paid more than $500 just to get a god damned referral, and just to re-emphasize this, we had health insurance.
I remember how upset and frustrated I was with that entire situation; it felt like I was doing things the "right" way by getting a desk job with health insurance and yet I still couldn't afford to get the treatment that my wife needed. It just felt...unfair? Like what exactly was I supposed to do differently here?
It didn't really "change" my perspective on this, I had already been in favor of moving to a universal healthcare system, but this thoroughly solidified my perspective on it.
[1] Fortunately, it wasn't that, it was an autoimmune thing. Still not great but better than we initially thought.