We’ve been fighting a hospital on an overcharge that drained our HSA account. Every person we talked to has been utterly flabbergasted that we are complaining because “it says here you owe $0”. They can’t get it through their heads that the insurance paid them with our own money, and that we’d like to be refunded the overage.
It’s just a confusing concept to these people. This is what happens when most people use someone else’s money to pay for things. Nobody knows or cares what anything is supposed to cost.
Small claims court if it's less than the relevant small claims amount.
Otherwise, a strongly worded letter from a cheap lawyer.
The legal system is often abused. But it sounds like you've got an actual legit issue, which is what the legal system is there for. Why not use it?
If you don't want to pay for a lawyer, you can write your own strongly worded letter. Just be sure to stick to facts, and keep very good records. In your letter, explain the issue briefly but clearly. Explain how you've attempted to resolve the issue. Explain how if the issue is not resolved, you will be forced to take action.
Address it to the hospital CEO, or whoever is in charge. Post it using registered mail.
Your local library may have a subscription to LexisNexis or a similar legal database. This will have form letters and chunks of legal text that you can copy and paste.
HN user patio11 wrote a thing about writing letters on this website that I can't just find. But find it, and read it. It also has helpful advice.
I think the reticence most people have with initially engaging with a lawyer is they're not only not free, but initially not cheap on account of the retainer fee.
Yes, you'll get anything not used back, but the last time I needed a strongly worded letter I had to pay the $1500 retainer and finding a lawyer under $200/hour in my area is extremely difficult. I got my remainder back the following month, but the strongly worded letter cost $400 and tied up $1500 for about five weeks.
The reality is the average person -- if we go off all the studies pointing out the large swathes of the population that can't meet a $500 emergency expense -- may not be in a position to tie up cash, even in markets where a lawyer is considerably cheaper. It's also a cost-benefit equation, and the value of that (regardless of the outcome) is different for everyone -- I'm someone who'll go tooth and nail to get $20 back on principle, but for some people that threshold might have to be $2000+ to care.
It's a little different. It's more like hiring someone as personal buyer who buys for likely a large group of people. A majority of people don't actually use the $3600+ they spend per year on health insurance so the money adds up fast and the buyer doesn't have time to deal with individuals so they don't seem to question paying $$$ for a tissue paper. The amount of money they are authorized to spend is so large that a $$$ tissue paper is just an insignificant percentage of the total available cash.
If hospitals and insurance companies are already tracking their income/expenses they should just be required to publish the anonymized data via a centralized API so we can all work on creating systems to analyze the average cost of the products. It will help insurance companies and patients as well as doctors and everyone in the end. Also, beyond the standardized API system which should easily cover all the standard financial points we can have multiple people / organizations analyzing the data.
Say one particular health issue shows up in the system as costing a lot of the insurance cash pool, we would notice it right away and could funnel more cash into prevention.
I'm not familiar with the industry so maybe there is already something similar available?
Whilst I can totally dig where you're going with this - love the idea of open API's... we know it aint a tech problem.
How did Europe do this with that whole payment services directive (I think that this is what I'm thinking about) - the one that forced all payment systems to have open APIs and such?...
How would we get something like this in the works? It would require a mandate from ??? Congress / the President / Bigfoot???
I can only imagine how these companies would not like this information out. Even if one were to explain that having this data would yield optimizations of their internal systems, saving them money, as the information would most likely make many within the organization look badly.
Not suprised.We used to have customer purchasing our services on a credit provided by a finance company,then cancelling and demanding full amount to be translated to their bank accounts... It usually take a bit of time for people to get it...
Your insurance has access to spend your HSA? That's certainly not how mine is set up, and I'm surprised that's even possible. Did you give them your account number and authorization to spend your money?
Mine are run by the same company and bills pass through. The result has the same effects for me as a PPO with a weird sort of IRA attached, and lower premiums than my old BCBS Elite 100/80 PPO.
That's just a fancy name for self insurance, i.e. no insurance. Somehow wrapping it in yet another siloed tax advantaged vehicle makes it sound better.
Of course. Even with a run-of-the-mill HSA + HDHP, you're basically partially self-insured and tasked with the thankless job of insurance administration. You can see there is something scammy about these things (in practice if not on paper) when they are so enthusiastically pushed by the healthcare industry.
You can be interested in the prices, but you won't find anyone interested in telling you the prices. You will also be met with complete incredulity when you ask about prices. (If you're asking about prices for a procedure or treatment related to your child you will also be shamed for "putting a price" on your child's health.)
Adding to this: Oftentimes there isn't a single person in the place that even knows what X costs...and hasn't a clue how to determine that number.
Years ago, I was between jobs and asked for the 'cost'. The reply I got was "$20", a typical copay at the time. When I explained my situation and was asking for the actual out the door costs...20 bucks. They really didn't even understand how to approach my question (could see it in their eyes/response). When I asked for another person in the office - 20 bucks. Hell, even the Dr told me 20 bucks. The bill I received was not 20 bucks - surprise surprise. And what could I do really - hold them to the 20 bucks? Where was my 'proof'...
Many of the people doing the admin work simply are not trained nor equipped to understand the gravity of the position. They can set you up on a calendar and fill out a postcard - beyond this, and there's problems. And why should they? They are being paid to be calendar/postcard filling person only.
The system itself was designed weirdly to begin with, it assumes that you are a wage earner of a large company that is paying insurance as an employment perk. If you deviate from this model - then these sub-systems don't know what to do.
They know what to do. But they are selectively "dumb." Do you think a doctor who runs a clinic and their employees, accountants, medical procedure coders, and insurance claims people don't know a thing or two about costs? How do they stay in business?
But if they told you some four-digit number you'd bolt.
We like to hold medical professionals in high esteem, but these days it's also a business transaction. They know this. As such they are very much a part of this very large problem.
Sure, but that requires a level of investment and effort that a lot of people simply don't have.
The last thing I personally want to do is have to argue with insurance companies and negotiate prices down through the labyrinthine healthcare system after dealing with enough nonsense at work. Even worse if I have to do said negotiation from a hospital bed due to an unforeseen problem, as most health issues tend to be.
when I need something, I usually don't have much luxury to 'shop around', and whatever price shopping you may want to try to do is often still hamstrung by 'in network' vs 'out of network' price tables.
I needed a procedure that was going to be ~$1500 at any one of a half dozen places within a 90 minute drive; some were a bit cheaper, but they couldn't see me for more than a month. There were a couple places that were ~$1100, but it basically would have been a whole day's enterprise for 2 people to get me there and back. To save maybe $400. $400 is not nothing, but I wasn't even actually 100% sure their pricing would actually be what we finally paid - no one could guarantee that. So we may have had 2 people take an entire day from earning on the partial chance of saving some money. Might even have been cheaper in another state, but then you've got travel/hotel costs to add as well.
"...no one could guarantee ..." Key phrase to be sure.
Many people that I know talk about how people need to know how much something costs - but these systems themselves don't know how much anything costs.
Furthermore, they know this and therefore unwilling to guarantee anything.
Knowing prices is great, but I feel is a non-starter when thinking about how the system can be 'fixed'. Also, you can't price shop when you're having a stroke.
All in all, we have to just acknowledge that the system for everyone is broken - beyond this, I haven't a clue as to the next step.
> Also, you can't price shop when you're having a stroke.
And you can't consent to anything when you're having a stroke, or in a car crash, or having surgery, etc. You're hit with thousands of dollars of bills when you're unconscious or not mentally competent, and it can stick with you for years.
Price shopping to keep costs down - yes, fine, it's a nice little component that would probably help a portion of our medical ecosystem. If I can save $14 on some particular medication by choice of pharmacy - sure, why not?
I've maintained for years - either single payer, and/or have insurance go to a primarily individual/family policies that people purchase themselves - get the employers out of my business. People are tied to jobs due to insurance concerns - employer-provided health insurance contributes to labor immobility. Employers have less incentive to hire less healthy people, likely keeping some people from improving their lives.
Remove 'tax deduction' for employers to provide health insurance. Ensure all taxpayers can fully deduct 'health insurance' costs from taxable income, starting from $0 (none of this 7% of MAGI bullshit). OR... increase it? 150% of your premium is deductible in year 1. 130% year 2. 115% year 3. 110% year 4. 100% year 5. Incentivize people to actually own this.
We had 18 months of "let insurance companies sell across state lines" BS during our last election. It's already possible between many states - it's simply far too much regulatory burden to deal with for most companies, that's why most aren't doing anything about it, even when they can.
REAL reform would be changing who actually pays for it - let them become the real 'consumer/customer'. An employers' incentives and mine don't always align, and if they're paying the bill...
No properly functioning market behaves like this.