Insurance, healthcare provider, apparent abuse, lack of transparency
"Just as with any other service provider - vote with your wallet. Do not go back to that doctor's office, and make sure they know why. It's unheard of that a service provider will not disclose the anticipated charges ahead of time. A service provider saying ""we won't tell you how much we charge"" is a huge red flag, and you shouldn't have been dealing with them to begin with. Now you know. how can we ever get health care costs under control if there's so   little transparency? I'm assuming you're in the US. This is not going to change, since there's no profit in not screwing the customers. As long as health-care is a for-profit industry, you should expect everyone in it being busy figuring out a way for money to move from your wallet to their. That's what capitalism is about." I wouldn't classify your treatment as abuse. Medical billing has become more complex not less complex. You need to learn to ask even more questions regarding expenses, you probably need to see these price quotes in writing. You did several things correctly. Staying in-network generally is best because many plans have two deductible limits: In-network, and out-of-network.  You need to make sure that the insurance company does credit you with having paid the new patient fee. That will qualify as an expense toward the deductible and your maximum out of pocket for the year. Some doctors offices don't send to insurance companies items that they know will not be covered, not remembering that these costs are critical under the High deductible plans with a health savings account. Doctors offices have problems determining how much the cost to you will be. It depends not just on the insurance company but also which type of plan you have, which sub-plan you have, and are you covered by more than one plan. Not to mention individual deductibles, family deductibles, and annual out-of-pocket amount. All this is wanted prior to the doctor seeing the patient. Most doctors offices will work with you, they know that each insurance plan treats each medical billing code differently, sometimes they make a mistake. Talk to them.
"What do you mean by ""interfering"" ? It sounds like you are making a negative judgement on gov controls. *Unbridled* capitalism is toxic - this is why America is a mess. Go read Adam Smith.  Other western countries have tight controls over healthcare .. and they get a better quality product at an affordable price." I'm not unsympathetic, but insurance of what kind? I don't know how he'd have owned a restaurant but failed to pay into the social security system. Was he paying taxes at all?  As for the 'why,' there's not enough checks and balances to make sure that nothing is done under the table. I believe 40 quarters of work would have qualified her for a benefit of some kind, but you say she didn't pay in either. Both people didn't pay into the system, either on purpose or by not understanding the need to do so. This is a sad situation. "This is one of those ""no shit"" articles. It's buried about halfway down that article, but then you find the concession that, among the group of working age men who were not working and using opiates, they found a large number had serious injuries and were taking pain medication, under a doctor's care, to manage that.  They also concede that the rates of disability is substantially higher among working-age men as well, and that frequently requires pain management -- and whether it's managed with ultram or heroin it's all counted the same in the article (and likely the paper, but I can't read it at the moment).  Further, since it restricts this to not in the labor force rather than unemployed + not in the labor force, two things happen: first, the public perceives it to be higher and more problematic because they think ""unemployed"" not ""non-participant"", and second it includes those who are undergoing chemo, hospitalized and dying, or otherwise under constant medical care that may *also* require pain management. It's not nearly as instructive as if this had included a breakout for the unemployed.  The paper is interesting and necessary, but this isn't really news." There are several assumptions you made, that don't match the current laws: Costs: COBRA: "In general, ""billed amounts"" don't mean a whole lot, since if the provider has a contract with the insurance company (usually called ""in-network""), the insurance company picks what the rates are that the treatment ""should"" cost, and how that cost gets allocated between what the insurance company pays and what the patient pays. Due to that contract, the insurance company and provider should agree on how much the patient owes, and one shouldn't pay a provider more than what the insurance company says you should. On the other hand, some insurance plans have a level of ""out of network"" coverage. In that case, the insurance company has its same sense of what the treatment ""should"" cost, but is really only concerned with paying its share. The EOB then should show how much they pay, but will generally show the full ""billed amount"" minus their payment as the amount the patient owes. That is, since there's no contract between the provider and the insurance company, the insurance company has no way to stop the provider from ""balance billing"" you for whatever they want beyond the amount that the insurance is paying, since any payment amount is purely a transaction between you and the provider. In general (as with anything involving large amounts of money), it's best to get all you can in writing. The provider should be able to provide you with a statement showing zero remaining due, and including both any payment you've made to them and any payments made by the insurance company. It may take a while for the payment from the insurance company to be processed, and until it does there may be something on the statement showing ""estimated amount to be paid by insurance"", which isn't as comforting as one showing ""actual amount paid by insurance"" and ""zero due""." "Here's another example of such a practice and the problem it caused.  My brother, who lived alone, was missing from work for several days so a co-worker went to his home to search for him and called the local Sheriff's Office for assistance.  The local fire department which runs the EMS ambulance was also dispatched in the event there was a medical emergency.  They discovered my brother had passed away inside his home and had obviously been dead for days.  As our family worked on probate matters to settle his estate following this death, it was learned that the local fire department had levied a bill against my brother's estate for $800 for responding with their ambulance to his home that day.  I tried to talk to their commander about this, insisting my brother had not called them, nor had they transported him or even checked his pulse.  The commander insisted theirs was common practice - that someone was always billed for their medical response.  He would not withdraw his bill for ""services"".  I hate to say, but the family paid the bill in order to prevent delay of his probate issues and from receiving monies that paid for his final expenses." It's possible.  Our healthcare systems is a serious mess, but universal healthcare could also make things worse.  The problem is that our healthcare system is afflicted by a litany of regulations neither guarantee care to the most vulnerable nor allow the market mechanisms to work.  The Mises Institute has a few good pieces on this ([here's one](https://mises.org/blog/how-government-regulations-made-healthcare-so-expensive)), but to put it very simply, the issue is we are letting bureaucrats run our healthcare instead of leaving medical choices to physicians.    I'd wager that NZ physicians have greater freedom to practice than US ones, but that's only a guess.  That's the key though.  Medical choices need to be left up to doctors and patients whether we adopt a market-oriented system or a universal care scheme.  If this isn't done, quality of care will be poor and costs (direct or indirect) will be high.  At the end of the day we could screw up either approach.    I will say, that I've read Sen. Rand Paul's [proposal](https://www.paul.senate.gov/imo/media/doc/ObamacareReplacementActSections.pdf) (not the current Republican plan) and it seems like a good example of practical market reforms. When I had a high-deductible healthcare plan, I used http://www.ehealthinsurance.com/ to do comparisons among the plans.  As far as comparing the costs of specific procedures across providers, I'm not aware of any good ways either. I don't want an underslept doctor anywhere near me.  That's how wrong limbs get amputated.  The fact that this kind of abuse happens with doctors is not a green light for cops to do the same. Oh man. That's awful. Thank you for sharing this.   Hey, I'm writing a larger piece on some of the challenges we face today, and both data overload and data legitimacy are a part of it.   It would be great to have someone inside the industry to talk to about this. When I get there do you mind if I reach out to you so I can learn more? "Article mentioned many treated are uninsured.  A sizeable quantity would be victims of crime.  There would need to be some kind of law that invokes tragedy or ""innocent bystander"" classifications for medical relief.  I don't know that such a law exists." "I had a similar issue take place at a hospital when the repeatedly billed the ""wrong me"" -- a stale insurance record left behind from when I was a dependent on my parent's insurance a decade earlier. They ended up billing me for anesthesia when I had a major surgery (everything else was billed to the correct insurance.) The outsourced billing people were pretty unhelpful (not usually the case with hospitals), so I became the squeaky wheel. I sent certified letters, had my priest rattle the cage (it was a Catholic hospital) and eventually talked myself into a meeting with the VP of Finance, who started paying attention when the incompetence of his folks became apparent. Total cost: $0 + my time." My dad runs an AV labor company (trade show setups etc) and his insurance company called him as they were finalizing his workers comp. They asked when he was submitting all of his employees drug screenings. My dad laughed at them and said he would not be submitting any. They told him his premium would be higher to which my dad replied that if he drug tested, he would have 4 people working for him and thus wouldn't even have a business - just send the bill. Unfortunately I've seen every single example you've provided from the health care providers perspective.  Trust me, they aren't happy about the situation either - hence the reason they will demand up front payment from you based on who your insurance carrier is.  I could name a few of the top brand name insurance companies in this country that do all of this to their clients.   Medical billing is an incredibly over complicated beast.  One that insurance companies have been doing everything they can to make worse over the years.  The codes can change annually and there are MANY different codes which can cover the exact same situation.  Sure the insurance company might cover gallstones, but if you happen to be pregnant, well, that may not covered even though the treatment is the exact same. What can you do? Consider locating a new insurance company.  You do have options and don't have to go with the one your company uses.  The downside is that this is going to take quite a bit of research on your part and it will end up costing you more money on your monthly premiums simply because your company won't be footing part of the bill.   Talk to other co-workers and see if their experiences match yours.  If so, try to get a large enough group together to approach management and demand resolution.   A third potential avenue is to get politically involved - but I'm enough of a pessimist that I doubt that would do any good.  From what I've seen, neither major political party's current position actually does anything to solve the problem. A fourth option is suing the insurance company - but that is going to be incredibly expensive and take forever.  You might have better luck getting together with a bunch of local people and demand your attorney general review the billing/payment practices. Again, this is going to require a LOT of effort. A fifth option is to attempt to cash pay your bills and submit them yourself to the insurance company for reimbursement.  If you do this you can likely negotiate lower bills with the medical provider.  For anything less than about $2,000 I negotiate the amount prior to service.  Believe me when I say that providers are more than happy to give decent discounts if they know they won't have to deal with the insurance companies themselves.  Slightly more work for you, but could be far cheaper in the long run. "I would phrase it this way: if someone needs costly procedures, especially for conditions they caused themselves, then, yes, those procedures will not be covered, and they are not covered in all National Healthcare systems in the world.  It's immoral to cover a liver transplant for a drunk or extended hospitalization for an obese person while an old lady cannot get an aid to stay independent in her home because it's not covered in the medical insurance.  And I have no issue if the ACA will be repealed before a replacement is put in place. This will be the fastest way to get a replacement.  It seems to me that you are not familiar with how National Health Care systems work, and so I will give you personal example, of my aunt, covered by the excellent national healthcare in Israel. And I mean it: it's one of the best National Health Care systems in the world.  Her hips locked suddenly and she had to have a hip replacement. ""No problems!"" said the doctors: ""You will get hip replacement, totally covered by the insurance"". ""But, you have to wait 3 months for that."" So my aunt said ""But I got supplemental private medical insurance"" (every one smart in Israel who can afford it get that.) ""Why didn't you tell us?"" asked the doctors, ""you will have the hip replacement done next week, with better parts."" And so it happened.  My aunt thought that, at least, the recovery and rehab in the hospital will be covered by her standard insurance. So, in the morning after the surgery, the nurse comes and says ""please make a choice: either I come once in the morning to take you out of bed to the toilet and some rehab, or, once in the evening"".  My aunt chose none of the options, and paid out of her pocket (partially covered by her private insurance) to stay in a private hospital.  Do you get it?  But in Israel, an obese women will get her 3rd artificial insemination to have her 3rd baby + an aid to help her raise her kids because she's too fat to care of the her children. We have that nonsense in Israel."