Bay Area couple shocked by $200K hospital bill for rabies shots
abc7news.comThat's a shitty bill. It's also insane that US doctors and hospitals aren't required to post prices, keep prices reasonably within an allowed range, and are allowed to price gouge customers for however much they want without limit.
In Redding CA, I ran across a woman with a nasal infusion pump tube taped to her face in a coffee shop. She was hurriedly collecting paperwork for a hearing across the street. It turns out she was preparing to go through bankruptcy proceedings while she was dying from incurable Stage IV cancer. That the doctors and hospitals were vultures picking her life apart for money while she was dying but still alive and making her end-of-life as miserable as possible was adding insult to injury. Some hippocratic oath. More like hypocritical chisels out to monetize misery.
So when someone is out of money and dying in America, they are treated like criminals with court proceedings. At their hearing, they get a chance to justify their existence requires clothes, transportation, and housing while everything else goes to creditors.
My mother got cancer (she survived it, fortunately). She had a fantastic insurance policy, made good money (well above the average income), and had money in the bank.
Her medical costs ended up bankrupting her. That was where the scales fell from my eyes and I learned that what we're taught about the purpose of insurance (to protect us in the case of a catastrophic expense) is just pure BS.
Was this before or after the ACA? As far as I understand it, the ACA got rid of ceilings on benefits and added a max pay per year.
Much before. But what did her in wasn't benefit ceilings, but rather the insurance company fighting everything they were obligated to pay out. it wore her down. It's very hard to fight the insurance company while at the same time fighting cancer. She got down to 80 pounds, couldn't eat, sleep, or do much of anything more than just hang in there. Constantly engaging in dispute resolution with the insurance company was not something she was capable of.
And they knew it. That's why they fought paying out every nickel. Evil bastards.
If it doesn't show, I have literally nothing good to say about the insurance industry.
Ok, I'm just wondering, because I think the law would firmly be on her side if it happened after the ACA was passed (they can no longer call policies with benefit ceilings as health insurance, you have an out of pocket maximum that is pretty hard set in stone...the dispute would just be in if something was covered at all or not). That still leaves plenty of things wrong with our system, of course.
Are there by chance companies you could pay to do this on your behalf as a service? (get the money owed by insurance) Seems like something ChatGPT would be good at, if this doesn’t already exist, and then the company would charge a small percentage of what they force the insurance company to pay. If ChatGPT can ace the bar exam, you’d think it could devour all the related case law and coverage legalese from your policy, and generate effective legal responses.
I assume you're using the word "fantastic" as in "imaginative or fanciful; remote from reality"?
I mean it as in "much better than average", of course.
I got charged $5000 for a 30-minute preventative echocardiogram (basically an ultrasound) that insurance was supposed to pay 100%.
20 emails later it's now at debt collectors, and I've contested the debt twice.
I'm ready to appear in court if I have to. I'm ready to pay $8K in lawyer fees to get rid of this $5K bill because it's wrong. I just don't want this to impact my credit score because it's not my debt.
I hate you, Stanford Healthcare.
Why didn't the insurer pay? Was it not covered? And what setting was it in, outpatient or ER? If ER then you should be able to dispute with your insurer to get it covered. If outpatient you might be able to negotiate with the Financial Services folks that they (the doctor) did not submit for pre-authorization appropriately per industry standards.
That's where you build your argument that they acted inappropriately and did not disclose prices (did they?). The next question is are you on a State plan or a corporate EIRSA plan? If State they you can file a complaint with the California department of insurance. If you have a corporate plan, which is likely self funded, then I would ask your HR to talk to your insurance rep. You might find things get retroactively covered at that point. Or you can talk to the news. They love to report on these things.
Stanford has pattern of inflated charges. Hearing tests in audiology for example are ridiculously overpriced without insurance and they don't pre-authorize. And most insurers don't cover hearing tests anyway. Stanford could fix this by not being greedy.
> Why didn't the insurer pay? Was it not covered? And what setting was it in, outpatient or ER?
Outpatient. Routine preventative care, I have a heart condition so echocardiograms are done every 2-3 years as a preventative measure. Insurance plan claims 100% coverage of preventative care with no deductible or coinsurance. I tried to dispute with insurance but they insist that it wasn't preventative (it's my body, my health, I know better than them that it was preventative) and they consistently would put me on hold for VERY long times on the phone until 5pm and then say "whoops, we're closed"
> The next question is are you on a State plan or a corporate EIRSA plan?
Self-purchased out of marketplace plan (HealthNet). I was self-employed at the time.
> Or you can talk to the news. They love to report on these things.
I would absolutely love if someone can put me in touch with a contact.
Look into https://www.dmhc.ca.gov/fileacomplaint.aspx
I imagine an expert from the DMHC can advise on your specific situation.
Oh my word.
2018, I was on Medi-Cal (Medic-aid) and had a stress ECG, right heart catheterization, and 12-lead EKG when admitted to their cardiac unit for 3 days. Cost $0.
Like a third-world country: in America, you're better off being either totally penniless or a billionaire. If you don't have a balance sheet of $5 megabucks, your life will be miserable.
The advantage most European and other countries have under socialism is it means there's a minimum average quality of life everyone. Pay more in taxes but get a lot more in terms of a more dignified, healthier, and longer life free from the slavery of "gotcha!" gangster capitalism.
> Like a third-world country: in America, you're better off being either totally penniless or a billionaire. If you don't have a balance sheet of $5 megabucks, your life will be miserable.
I live in a "third-world" country. My family and I have insurance and only use private hospitals -- the capitalist portion of the system. Never had as bad an incident as the ones you guys are reporting here. Just some minor annoyances.
Not even the crappiest insurance companies do stuff like that, and they get terminated by the regulatory body if they start to mess up consistently.
Although I don't use it directly, I'm overall well-informed about the realities of the public health system. It's bad, but not even close to what I've seen posted here. One can even obtain overly expensive meds for rare diseases -- it requires some legal effort, but it eventually works.
Then I'd say that, when it comes to health systems, the USA is definitely way worse than some third-world countries -- and one of the main reasons I declined an invitation to work and live in there.
When I was living in China working for Microsoft, our company provided insurance had a cap on claims paid ($100k), so while everything was cheap enough via the private system, I wondered if I was screwed if I ever got cancer or something really bad.
Yeah that doesn't sound like insurance to me at all.
It used to be common here in the US too, to have a cap on the amount an insurance policy would pay out.
My first “adult”/non-parental healthcare insurance policy had a yearly maximum and a lifetime maximum. This was pre-Affordable Care Act.
> The advantage most European and other countries have under socialism is it means there's a minimum average quality of life everyone. Pay more in taxes but get a lot more in terms of a more dignified, healthier, and longer life free from the slavery of "gotcha!" gangster capitalism.
It will sound like a nitpick but it's not: there's no socialism in Europe. Socialism is an economic system, not a synonym for "socially-focused policies" through societal-level welfare.
European countries are capitalists, completely. What we do have is a better support system for welfare, more labour protections and regulations to protect against the massive power imbalance that untamed capitalism creates but it's not socialism. Not even close.
> It will sound like a nitpick but it's not: there's no socialism in Europe.
If Europe has no socialism they've still somehow managed to end up with a lot of European Socialists (https://en.wikipedia.org/wiki/Party_of_European_Socialists). Some words are basically meaningless because everybody has their own definition for them and socialism is certainly one of those words. It's probably better to avoid the term entirely and just describe what you mean because some people get so emotional just hearing it that they seem to lose the ability to think.
Words have meaning, socialism has a meaning:
> Socialism: a political philosophy and movement encompassing a wide range of economic and social systems, which are characterised by social ownership of the means of production, as opposed to private ownership.
That is the meaning, it's not meaningless. It becomes meaningless when people just accept that it can mean anything they want, it can't. Socialism has a very specific characteristic: social ownership of the means of production.
If people misuse the term they need to be corrected. At least until the meaning completely shifts to something else, like what Americans try to do with the term "liberal" which does not, at all, mean "progressive" as is the usage in the USA.
Words do have meanings, the word socialism has so many meanings that using the term just makes things less clear. Even your preferred definition is so overbroad that it strains usefulness. Any definition that lumps together the political philosophy of Keir Starmer with that of Joseph Stalin is one of questionable utility.
That's the thing, it does not lump Keir Starmer's political philosophy and Stalin's. To be defined as socialism it needs to encompass the social ownership of the means of production, Keir Starmer's economic-political philosophy does not encompass that and hence it's not socialism...
It's the one of the most defining characteristics of socialism, if Keir Starmer is not defending that the ownership of the means of production should be socialised it is not socialism.
Doctors are NOT to blame here. It's almost as inscrutable and impossible for them to understand the process as the patients. Doctors often times have to battle insurance companies on behalf of the patients to get them the drugs they need with coverage. My wife is a cancer physician and spends hours on the phone convincing insurance companies that patients actually need the treatments she's proscribed. It's an infuriating waste of time.
She also has little to no visibility into cost incurred by the patient, and often times there isn't a menu of options to pick from. She's not incentivized to perform extra testing/etc, and keeps patients costs in mind while providing care. I don't think that's rare among doctors. The whole system is frustrating, but yes mostly so for the patient.
Doctors could, to some approximation anyway, go on strike. They endorse the system we have by working in it (and have not been silent participants in building either).
It seems uncommon for one group to strike on behalf of another group. Pragmatically that seems very unlikely to happen even if theoretically possible. Policy level changes seem more likely to me.
That is by design. Look up the Taft-Hartley Act. Secondary striking is a forbidden labor practice in the United States. Any doctor's union that orchestrated one would be in hot water legally. It would essentially have to be a collective action orchestrated by distinct individuals with no legal entity providing any type of war chest.
To be clear, I believe at least that section of Taft-Hartley is arguably unconstitutional, and worthy of getting civil disobedienced hard. I just don't see it as likely to happen in such a way as to be effective in facilitating change. Add on top of that the onerous burden of medical school debt, and I don't exactly see many being willing to make that choice.
Okay, but the point is sort of that doctors are not in fact blameless for the system that they helped build and continue to participate in.
Like sure, they aren't solely to blame, and it would probably be hard for individual doctors to successfully push for systematic changes, but the flip side to that is that they don't get to say "Oopsie doopsie, it sure isn't great".
I disagree. Doctors did not build the insurance billing system that we have today, and are not implicated in creating the incredible complexity and challenge that exists for patients. They provide the care, and don't get to view the costs born by patients.
That particular deck is stacked against the favor of doctors and patients.
After all, a care facility can probably be reasonably confident that if a patient needs help, doctors will feel compelled to care for them.
Put another way, would you want to walk into a hospital/ER/your doctors office for something acute and get an apology that care is unavailable because the doctors are on strike?
I imagine he’s suggesting a strike where they do not fill out the necessary billing paperwork, like Japanese bus drivers didn’t collect fares or the Canadian customs officers didn’t collect tariffs during their strikes. Not sure if that’s possible, but that’s how I’d think they can strike.
This would absolutely work when the EHR/EMR is down. Otherwise, most of that stuff is automated and pulled directly from the medical/surgical records in the EHR/EMR.
Providers are a full half of the problem! We live in a market economy, and it is doctors' responsibility to be able to answer straightforward questions about how much various treatments will cost, just as every other profession gives quotes and estimates. Pretending that money doesn't exist is doing a grave disservice to patients, for whom money most certainly is a concern.
In the short term, I know it's a tall ask for a provider to be able to tell a patient how much care from other providers might cost. But providers could certainly start by knowing the prices of services that they themselves perform. And if that's too hard because their billing departments have made it opaque with a whole slew of prices depending on who might be paying, then providers need to work on reforming their own houses before pointing fingers at the other half of the problem.
Hospital administrators don't take a hippocratic oath, unless they happened to also be doctors too.
Most were. Still, their staff do. But the point you're appearing to make normalizes injustice if they didn't happen to take an oath. What does this have to do with anything?
The vast majority of hospital admin staff aren't. Plenty of secretaries, orderlies, cafeteria workers, and janitors. The accountants, IT, lawyers, and HR probably weren't doctors or nurses either.
Only pointing out that many didn't take an oath, not that what they're doing is ethical. Holding people to an oath they didn't take doesn't make much sense.
Hospitals have been required to post price lists for several years.
This won't be effective unless the hospital is required to provide prices whenever people ask, such as requesting an estimate from your car mechanic. And not only providing the prices but being required to honor the price they give you, with some reasonable threshold of variance.
These hospitals posting their prices reminds me of this classic section of "The Hitchhikers Guide to the Galaxy":
"But the plans were on display..."
"On display? I eventually had to go down to the cellar to find them."
"That’s the display department."
"With a flashlight."
"Ah, well, the lights had probably gone."
"So had the stairs."
"But look, you found the notice, didn’t you?"
"Yes," said Arthur, "yes I did. It was on display in the bottom of a locked filing cabinet stuck in a disused lavatory with a sign on the door saying 'Beware of the Leopard.'
Due to the No Surprises Act, healthcare providers are now legally required to give patients a good faith cost estimate in certain circumstances.
https://www.cms.gov/nosurprises/consumers/understanding-cost...
It's meaningless unless you can get a price before you get services.
The trouble is even if the price list says $500 for something, they'll charge you $8000 for "general classification" and $2000 for a Tylenol.
I have a remote heart monitor at my bedside that, upon pressing a button, wirelessly retrieves data about arrythmia incidents from my implanted defibrillator and sends any incidents to the hospital. Every time I hit the button, even if there are ZERO incidents for them to review, I get hit with a $300 bill for some "general classification". So I hit the button less often than I'm supposed to.
Exactly.
Come in unconscious and bleeding out from a car wreck: "No, no, no.. take me to the other hospital with lower prices. And I don't want $100 acetaminophen."
Not all hospital visits are emergencies. I had an implanted defibrillator replaced recently. It's a life-saving device but I had a 3-month window to do it, so I most definitely picked "the other hospital" that I didn't have billing issues with the last time.
Also, a car wreck should not be a reason to nickel-and-dime someone unreasonably. And if I knew they were giving me acetominaphen for $1000 and I could wait it out for an hour I'd 100% refuse it and ask a family member to bring me some from Walgreen's for <$10. I'm not exactly swimming in money here.
From this recent HN thread it looks like we still have a ways to go there: New health insurance "transparency data" looks suspiciously wrong
Doesn't matter. Nothing has changed.
Somewhere in the hospital conference rooms, a model employee was giving a presentation about "average customers lifetime value (LTV) had increased by 25% YoY" thanks for his hard work. His promotion was finally approved that year. An accountant in an adjacent department was given a bonus for spotting a billing mistake that significantly underbilled a customer with stage 4 cancer. He was made employee of the month.
> The hospital is required to make its charges public. NorthBay Health's online listing shows $547.65 for a rabies vaccine.
Does this price include administration of the vaccine as well or just the cost for the vaccine with syringe and professional services additional?
I checked the price at my local discount chemist. 115AUD or 76USD.
> It's also insane that US doctors and hospitals aren't required to post prices,
This doesn't get a lot of attention because, well, what media outlet could write a positive article about Trump & get away with it, but healthcare price transparency was a big issue of his and during his administration the Hospital Price Transparency Final Rule was established.
The rule was issued by the Centers for Medicare & Medicaid Services (CMS) in November 2019 and requires hospitals to post prices.
The Trump administration argued that the rule would help to empower patients by providing them with more information about the costs of healthcare services, and that it would promote competition among hospitals and other providers, leading to lower prices and improved quality of care.
The rule was initially challenged in court by a group of hospital organizations, but in June 2020, a federal judge upheld the rule, clearing the way for it to take effect on January 1, 2021.
> Tens of thousands of people each year receive a series of shots to prevent rabies after a possible exposure. It normally costs between $1,200 and $6,800. Not in this case.
Even that "normal" cost is absolutely crazy.
Most Americans don't realize how bad they have it. They've grown accustomed to being punched and slapped around and so won't rebel. They'll keep giving all of what little and shrinking of what they have to legitimized criminals.
How? They don't have internet?
Even in Zurich, Switzerland, one of the most expensive places and healthcares in the world, it's 85 CHF / shot:
https://reisemedizin.uzh.ch/en/pre-travel_advice/rabies
Emergency room is 50 CHF extra in non-emergency cases:
https://www.thelocal.ch/20210617/emergency-room-visits-to-no....
We do have Internet, but we've gotten used to being told that the Internet lies to us. We've been repeatedly told that people wait months for treatment in the UK, and that Canadians are streaming over the border to get health care in America.
We read horror stories like this one, but say "Whew, glad that won't happen to me." We imagine that because of capitalism, if our insurance company screws us over, we'll change to the next one -- freedom we wouldn't have if we had a national health care.
It never seems to occur to us that all of the private insurers have a capitalism-driven goal of maximizing profits, and national insurers don't.
How is that legal? What is stopping the hospital from charging 200 million dollars for the rabies shots?
If I hired someone to fix my plumbing and they wouldn't give me an estimate and then decided to charge me $20k/hr I don't think a court would honor that contract.
It's legal and legitimized because of corruption.
Whoever has the most money in America captured the regulators and politicians through money conveyed to them by lobbyists.
You live without plumbing by making different arrangements but you can't live with a fatal lyssavirus.
I'm not sure about that. Hospitals use the fact that patients have no choice. Amoral business is the most profitable. A pipe in your house has burst, you called a plumber and he arrived in 1 hour (other plumbers were even further). He looks at your situation and says "sign here, my rate is 5k/hr plus unexpected expenses up to 50k" and when you try to negotiate, he calmly looks at water flooding the second floor in your 2mln house and answers nothing. You both know that very soon the repairs will cost you 100 thousands of dollars. I doubt any judge would agree that the plumber owes you work at a rate convenient for you.
Sure the plumber is free to only offer outrageous rates but I'm not sure they would be able to markup a roll of teflon tape they used in the repairs as 50k and say that is covered by "plus unexpected expenses up to 50k".
To me it just seems like fraud. Forget about patient choice because in this situation the patients conceivably could have shopped around for rabies shots, AFAIK you aren't going to die because you got your rabies shot a few hours later the you needed to. The problem seems to be that even if they were able to shop around and find the lowest price apparently the hospital can just charge whatever they want regardless of the expected or quoted cost.
Going back to the example of the plumber; Imagine if my house is flooding and I get into contact with two plumbers, one tries to price gouge me and quotes me $5k/hr and one is seemingly honest and quotes me $80/hr. I go with the plumber that quotes me less but then he ends up charging me $50k for the teflon tape he used anyways. We can see this isn't a breakdown in being able to shop the market and the normal competitive dynamics that arise from that, the breakdown occurs because of the fraud.
It's the gambit of brinkmanship + Vito Corleone.
Hospitals are required, under federal law, to list all their prices publicly.
The insurance company paid $58000 for the treatment? How the hell did they not get the hospital to get things fixed? My insurance made me submit proof, rejected it, submit proof again, partially approve, call them and then finally reimburse my $18 covid take home tests. But somehow they don’t do the same to hospitals?
What's their incentive to reduce the cost?
They make money as a % of care paid out (max profit is capped).
More costs == more profits and the costs are just passed onto the people paying for insurance (both employees and employers)
In a normal competitive market a series of new entrants would come in and undercut the incumbents by charging 10% less than the competition, one after the other until a sensible price is reached. Why doesn't this happen? Also where does all that money even go? It's so insane.
Medical licensing. Can't practice medicine without a license. And if you're a doctor and you strike out and practice medicine on your own, a.) where are your hospital affiliations? your equipment? your support team of nurses & orderlies and b.) who's gonna pay your own health insurance?
Money goes mostly to the salaries of healthcare administrators and dividends for shareholders, with enough going to doctors and nurses to keep them from striking out on their own.
This is not a competitive market. It is a completely regulatory-captured market.
There is no incentive except to commit highway robbery.
Pay, or pay and die.
It's the weakness and disorganization of the consumers who emboldens them.
I once dropped in to a hospital near Vacaville, maybe the same one.
There was a security guard at the front with a grey keypad. The would not speak to you unless you entered your Social Security Number. I made the mistake of entering it but thought nothing would happen because I didn't see any live human. Guess what? $800 bill for the pleasure of seeing exactly no service provider. This is how they work.
Did you pay it? If so, why?
So many anecdotes end with "they sent me a bill", without saying what happened next. Just because someone sends you a bill does not mean you have to pay, especially when that bill seemingly isn't based on a contract or other form of legal liability. Did you tell them to go screw, they took you to court, and they actually managed to substantiate the debt? Or if you were worried and strapped for time and just gave in to the extortion, please let us know that.
The funny part is that US people are paying more (2x) for public health (not private) than the average european and receiving nothing in return... And they say public healthcare is communism. That shot in my country would cost 0. Like a cancer treatment or giving birth. Just 0. That's why we pay taxes.
I'm glad I don't live in the US.
https://www.healthsystemtracker.org/chart-collection/health-...
Does anyone have advice on how to protect yourself from bills like this?
My insurance is fighting me on a $450 test (that I could have gotten done with an Amazon kit for $80).
I am so happy that I don't have to put up with crazy shit like $200k for a few shots which is NOT just a billing failure, just by not living on the other side of the Atlantic...
Because here where I live, if you walk into an emergency room and walk out a few hours later with two shots and a $200k bill, ... well it's unthinkable, but if it happened anyway and the hospital tried to defend it, the judge would just laugh their lawyers out of the door.
Absolutely insane that they would have been better off heading to SFO, walking up to the Air Canada or Aeroméxico counters, and leaving the country for care.
Or just get a private flight...it's much cheaper than $200k
Brazil here. A few years ago, my wife was bitten by a dog. We simply went to the neighborhood free healthcare clinic, the standard entry point to our free universal healthcare system. After a very short wait they cleaned the wound and administered the first rabies vaccine. We went back there for the next doses. All free of charge, and the only "paperwork" she needed to do was to present her national ID card.
https://en.wikipedia.org/wiki/Sistema_%C3%9Anico_de_Sa%C3%BA...
This thread isn't about developed countries
This is pretty much how things go in Australia for the poorest to the richest citizen.
The USofA has an unbelievably shitty healthcare system.
Wikipedia says it's free for foreigners and nationals, so I'm curious why they require the ID.
I am pretty sure that ID is not required, but they ask for it, so that they can access and update your medical records.
I'm not in the US, is medical tourism common amongst US citizens? For non-urgent cases, why not travel to a country that offers cheap, quality health care? Financially seems justifiable, given that in the US, simple treatments and medical procedures can cost many 000s without any transparency ahead of time.
People go to Mexico all the time for medical and dental procedures.
Michael Moore made a movie on this topic. Barely anything changed except what's left of Obamacare.
TIL Vacaville is considered Bay Area... that's a pretty far drive from SF.
Cow city. It's a shithole halfway to Sacramento.
A woman crashed her car into my vehicle there. She didn't stop. A cop was right there and did nothing. I called 911. The county or city didn't have E911 properly configured with Verizon and couldn't get my location. This is how America works. Broken, lawless, and dysfunctional.
Probably a DFT^P03 message caused an issue somewhere... Or this was to be... "CDPH does not have a role in setting charge limits or ranges for services."
Sadly, my first reaction to the headline was "why shocked, I thought that sort of thing was standard in the US..."
This is another of those cases which seem to be very clearly price gouging, which is illegal, unless you're a hospital.
The hospital should be subpoena'd to get the actual cost of treatment - both the vaccination, the amount paid to the ER staff during the time the patients were there, etc.
Also this BS where they can just say "out of respect for patient privacy we don't discuss billing matters", when the patient has provide explicit documentation and consent saying the hospital can discuss billing can also get shafted.
I won't attempt to defend the hospital but even outside of healthcare, price gouging is almost always legal. There are only a few limited circumstances where it is banned in a subset of US states.
"Price gouging" is only legal when a contract is formed. A contract requires well defined consideration, as well as a meeting of the minds - neither is present when a person is not told an up front price (especially after asking), and is under medical duress.
Did you know your little printed recipt is a contract?
It's better described as evidence of a contract. But I guess a signed piece of paper is merely evidence of a contract as well, despite being commonly referred to as "a contract".
But this isn't really relevant when discussing healthcare, because the problem is precisely with providers not dealing in specifics that would be necessary to create a printed receipt. It would be a terrible system if hospitals demanded full payment ahead of treatment and price gouged patients on the spot, but it would be significantly more legitimate than what we currently have!
I needed rabies shots before I went to South America. The NHS doesn't cover the vaccine but they will stick it in your arm for free. So I spent £50 at a pharmacist for the three phials and the nurse at my doctor's surgery administered the first two. The last dose was due the day before I left but the nurse was off sick. So I rang another local surgery and the nurse there was happy to do the job. The American system baffles me.
What happens if you refuse to pay?
They give your rabies back.
https://news.gallup.com/poll/317948/fear-bankruptcy-due-majo...
https://www.texastribune.org/2022/06/16/americans-medical-de...
https://www.retireguide.com/retirement-planning/risks/medica...
It really bothers me that none of these stories seem to describe what legal theories are used to enforce these fabricated "debts" against the victims. It would seem there must be a whole collection of state laws that enable these practices, and I would think they would be a prime area of reform - if they were eliminated, providers would have to publish prices and form an actual contract (including a lack of duress and well-defined consideration), instead of being able to play this game of "nobody can tell you how much anything costs until the billing extorts you".
I'll just leave this here:
https://www.npr.org/sections/health-shots/2022/12/21/1144491...
Debt collectors, A lien on their house, etc
Dispute the debt.
They can't put a lien on property without a court case and I want to see someone stand in front of a judge and justify an un-itemized 100k bill when their own public charge sheet shows that the service should cost <1000.
That doesn't work in the real world. Their army of lawyers can and will outspend you at every turn.
They will force you into bankruptcy when you should've declared bankruptcy to begin with.
There's no spending involved on your part. Don't spend a dime until you show up in court to defend yourself.
"I've been asking for 2 years for a breakdown to explain how what is listed on their website as a $600 charge became a 120k charge."
But do they want to outspend you? Especially if the case is not a sure win for them.
So the real disruption would be to DoS their lawyers by patients disputing absolutely everything questionable. Create an app to upload all the EOBs and make it dead simple to create grief for the hospital.
If they’re paying the lawyers regardless (as in paying them a salary), might as well give them some work.
Louis Pasteur is rolling in his grave. The 3 shot rabies PEP vaccine costs $108 while in the US it costs $1000. Same shit, American patients just receive the privilege of paying more.
So healthcare costs like 500-1k per month for the good stuff. And you still might have to pay through the nose for a £75 vaccine?
Or is this a case of bad insurance?
That the US can spy on the entire world but can't get its own people basic healthcare is shocking.
No, it depends on your age, health, and coverage. For limited disastrous healthcare coverage, that might get you $1m in lifetime coverage with a $8k deductible if you were 28 and in perfect health.
You didn't say how much that would cost.
I encountered a bat many years ago acting erratically inside the house. It had evidently entered in my sleep.
I looked up the cost, and found out the household would be bankrupted by the shots and we would end up homeless. I calculated the danger from homelessness outweighed the risk of rabies. I guess the bet paid off, as we're now well past the 99th percentile of incubation period.
Dang. I don't have a lot of financial reasons to prefer living in Canada, but that's definitely one (for now at least).
That's rough though, lucky you didn't get sick. It's not a choice I'd like to make.
Seems pretty remote chance to get rabies without being bit, but did you read the last paragraph?
"The Aguilars wound up paying $3,546.64 out of pocket. The insurance company told us Wednesday that they "are reaching out to NorthBay Healthcare... to address these excessive charges.""
The shot normally costs ~$600 USD. There is no way the insurance in the end will pay the $54k the hospital tried to get away with.
> Seems pretty remote chance to get rabies without being bit
Just FYI, it's possible to get bit by a bat while sleeping and not realize it. Most bats are small and a bite mark may not be painful or immediately noticeable. There was a case in 2021 in Illinois of a man being bitten by a bat in his sleep; in his case, he realized he'd been bitten, but declined treatment (cost, probably...) and died of rabies a month later. Not a fun way to go.
I've heard the advice before to get a prophylactic rabies shot if you find a bat trapped in your house while you were sleeping. ...in civilized countries, anyway.
edit: https://www.npr.org/sections/health-shots/2016/06/02/4804145...
> United Healthcare still paid more than $58,000 for the couple's rabies treatment
They did.
Says in the article they are contesting it. I am guessing in the end they will be made whole. The only more vicious actor in this situation is the insurance company.
If I recall correctly we had no insurance at the time. I was able to afford to re-vaccinate my animal, as it's only $60 at the vet, I figured at least my pet would survive.
It would almost definitely have been cheaper for you, without insurance, than it was for this couple.
Can you get rabies still, theoretically, from this event?
I believe it’s only transmissible through saliva. Unless you are bitten by the infected animal you will be fine.
Theoretically, yes. The infection can lie dormant for an exceptionally long period of time in an exceptionally small percent of cases and can be triggered by unrelated external factors.
so a whole story about a billing mistake, which they could have figured out without involving the news org?
Where does it say it's a billing mistake?
The article does not say it's a billing mistake, but it notes that NorthBay Healthcare lists a price online of $547.65 for a rabies vaccine. Surely human rabies immunoglobulin would be another $1,000, maybe more, but there is no chance on Earth that it is $100,000 each.
NorthBay Healthcare is a non-profit hospital.
This is a very, very obvious billing mistake. And while I have zero evidence for what I am about to say, I would be willing to bet that ABC7News did not even share the case they were preparing to discuss with the hospital. They just wanted to run the story, and so they asked the hospital for generic comment about a patient's large bill.
I've looked for follow-up to this two-month old story, and I can't find any. But I am sure it's a billing mistake.
Thanks for pointing out that this article is not brand new. I’m curious to see if there is an eventual follow-up. If not, then that would be extremely disappointing.
“Billing mistakes” happen way too often in this country and the hospitals don’t fix them that easily.
Good luck with them ever admitting to any mistake. They have collectors who don't care who will suck every penny. Just don't get sick in America.
The insurance paid out 58,000, the couple paid out 3000-something. So even if the initial 200k was a 'mistake', the actual billed service is insane for a $600 shot (2x). The entire bill should have been much less than their out of pocket.
So there is more to the story.
Agreed while this is excessive, many hospitals do this to cover the uninsured who don't pay their bills. Hospitals have to care for such patients due to EMTALA. Consequently many non-academic hospitals are under huge financial stress (https://www.kqed.org/science/1981588/half-of-california-hosp...) and go after anyone that can pay to the point of bankrupting them. The US medical system is simply dysfunctional.
> The US medical system is simply dysfunctional.
That's an epic understatement. I'm of the opinion that the root cause is the insurance companies.
That's an overly simplistic hot take. You have to look at the interests involved.
Sure, in some other countries, for-profit health insurance is illegal.
There are many more for-profit hospitals in the US than there were 40 years ago. Many not-for-profits sold out to for-profit companies. I believe John Oliver or VICE did a piece on this years ago.
Then there are the doctors. Only in the US is being a doctor insanely lucrative. Not all US doctors are out to financially abuse patients, but there are enough who are complicit in the hospital and outpatient practice system who enable mass exploitation.
Single-payer wouldn't end this. Medicare for all wouldn't even be close to fixing the problem. Most of Medicare is administered by for-profit health insurance companies. Medicare pays, but doesn't cover 100%. It still requires paying for one of a laundry list of letters Medicare supplemental and prescription plans. Also, the US doesn't have a functional mental healthcare system. And that's not covered either. Dental and vision also aren't covered.
> Only in the US is being a doctor insanely lucrative.
And only for some doctors. Most aren't making crazy money at all.
> Single-payer wouldn't end this.
I never said it would. But this is a thing that most other modern nations have figured out (imperfectly, sure, but orders of magnitude better than we have in the US). It's insane that the US can't seem to resolve this situation, especially considering that it kills people.
But then, we here in the US don't seem to prioritize actually helping people. The US is the wealthiest, most powerful nation in the history of the planet. That we allow anyone to go without a roof over their head, food in their belly, and adequate medical care is criminal.
These sort of stories like these go viral. The amount paid is nowhere close to that, sometimes nothing is paid. The final price is always negotiated vastly lower. The patient often pays a tiny fraction of this. It's bad that this happens in the first place though. There is something wrong when people getting these outrageous bills in the first place. Hospitals send out these bills in the hope a tiny fraction of people pay in full.
> The amount paid is nowhere close to that, sometimes nothing is paid. The final price is always negotiated vastly lower.
Wow, look at the Stockholm Syndrome on this guy!
As if that's an acceptable normal process for anyone to be subjected to...
Looks like there was already an outrageous payment:
> Even with plan discounts, United Healthcare still paid more than $58,000 for the couple's rabies treatment.