Author Topic: Facebook hospital screws everyone with private insurance  (Read 869 times)

MillCreek

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Facebook hospital screws everyone with private insurance
« on: January 07, 2019, 02:05:46 PM »
https://www.businessinsider.com/zuckerberg-san-francisco-hospital-criticized-for-surprising-patients-with-big-bills-2019-1

https://www.vox.com/policy-and-politics/2019/1/7/18137967/er-bills-zuckerberg-san-francisco-general-hospital

I had not previously heard of a urban hospital that did not participate in any private insurance networks. That means any patient there with private insurance (Premera, United Healthcare, etc.) is going to end up with a huge out of network bill. I wonder what the rationale is for not signing up with any of the insurance plans.  I see they claim that as a  hospital serving large numbers of uninsured, they have to make it up by screwing over people with insurance.

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Brad Johnson

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Re: Facebook hospital screws everyone with private insurance
« Reply #1 on: January 07, 2019, 02:25:54 PM »
Back when I was paying for my own I was on an Obamacare BCBS policy. Somewhere right around 2015-2016 all of the Texas BCBS Obamacare policies went HMO and most of the local hospitals and physicians' groups stopped taking it. I had to do some pretty fancy scheduling footwork to bridge the gap between the BCBS change and activation of employer-provided insurance.

I can see that potentially being the issue here. They specifically mention stuff like employer-provided policies. A lot of those are heavily network-based and probably couldn't come to an agreement with San Fran General on care costs.

Brad
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K Frame

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Re: Facebook hospital screws everyone with private insurance
« Reply #2 on: January 07, 2019, 03:25:15 PM »
20 or so years ago I had a dentist that I absolutely loved. Unfortunately, he didn't participate in insurance. I finally had to call it quits and go to an in network dentist when the out of pocket expenses got out of hand.

Fortunately I've been able to find several additional dentists whom I like just as much and who do participate in my insurance.
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K Frame

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Re: Facebook hospital screws everyone with private insurance
« Reply #3 on: January 07, 2019, 03:26:41 PM »
Whoops, wrong thread.
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Ben

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Re: Facebook hospital screws everyone with private insurance
« Reply #4 on: January 08, 2019, 11:34:43 AM »
That was a surprisingly good article for Vox.

While if i walked into their ER, I could quickly ascertain if I wanted to be treated there (i.e., they accepted my insurance), there is something morally wrong to me about someone incoherent or unconscious being taken to an ER and then finding that hospital doesn't accept their insurance. Knowing that the $730/mo I now pay for health insurance might be useless in an emergency (when my bills are likely to be at a very high rate) is infuriating to me.

I don't know what the answer is, but the explanation of the Zuckerberg hospital spokesman is not it. Their emergency room is almost like a small town speed trap in a B movie.
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MillCreek

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Re: Facebook hospital screws everyone with private insurance
« Reply #5 on: January 08, 2019, 12:09:39 PM »
^^^To build on Ben's comment, I am waiting for someone to blow the lid off air ambulance charges. Much of the time, the patient is unconscious or is otherwise in no position to refuse air transport.  Combine this with the hospitals and/or the air ambulance companies love to launch their shiny toys because they don't make money on the ground.  The patient gets a 20 minute flight to the hospital, which likely could have been done via ground transport, gets a bill for $ 40-50,000, the patient's insurance pays $ 10,000 of that and the patient gets a balance bill in the mid-five figures.  Good luck paying it.
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Quote from: Angel Eyes on August 09, 2018, 01:56:15 AM
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Brad Johnson

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Re: Facebook hospital screws everyone with private insurance
« Reply #6 on: January 08, 2019, 12:10:47 PM »
Don't most insurance policies have an out-of-network ER coverage section?

Brad
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Marnoot

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Re: Facebook hospital screws everyone with private insurance
« Reply #7 on: January 08, 2019, 12:15:56 PM »
Don't most insurance policies have an out-of-network ER coverage section?

Brad

Yes, and in the linked story the patient's insurance did cover what they considered a reasonable amount for the procedures performed. Problem is the hospital charged more than 6X the reasonable amount.

MillCreek

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Re: Facebook hospital screws everyone with private insurance
« Reply #8 on: January 08, 2019, 12:57:30 PM »
^^^And note further that the hospital stated that they did this to help subsidize their operations in taking care of the uninsured or on public assistance. So they stay out of network and charge people with insurance more to help cover the costs of taking care of poor people.   Rarely do you see a healthcare facility stating this so explicitly.
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Quote from: Angel Eyes on August 09, 2018, 01:56:15 AM
You are one lousy risk manager.

AmbulanceDriver

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Re: Facebook hospital screws everyone with private insurance
« Reply #9 on: January 08, 2019, 01:24:36 PM »
^^^To build on Ben's comment, I am waiting for someone to blow the lid off air ambulance charges. Much of the time, the patient is unconscious or is otherwise in no position to refuse air transport.  Combine this with the hospitals and/or the air ambulance companies love to launch their shiny toys because they don't make money on the ground.  The patient gets a 20 minute flight to the hospital, which likely could have been done via ground transport, gets a bill for $ 40-50,000, the patient's insurance pays $ 10,000 of that and the patient gets a balance bill in the mid-five figures.  Good luck paying it.

Yay, I get to tell my favorite air ambulance story again!  Now I'll preface that in my area, we are actually pretty conservative with using air ambulance services.  We've drilled into our medics that it has to save a minimum of 30 mins over ground transport (including the time for the air ambulance to respond to the scene, load the pt, etc).   So in most cases, we usually won't even consider flying the pt unless we're 60+ minutes from a trauma center (the vast majority of the air ambulance flights here are serious trauma).   And usually we'll only fly them if they meet the mandatory trauma system entry criteria.

Anyways, back to the story...  So we get called to a horse stable that's about 60 minutes from the local trauma center.  Right on the border of where we would usually consider flying a patient.   They do a summer camp for kids with behavioral issues in partnership with one of the local care groups....   So teen girl falls off a horse.  This is an indoor arena, with what looks like a foot of sawdust on the ground.  I'm seriously surprised the horses can even walk on it it's so springy.   So this girl starts claiming that she hit her head, that she blacked out, and she couldn't see....  911 gets called, and the volunteer fire dept gets there before we do.  And these guys go full on balls to the wall mode.  They're all EMT's (since it's a volly dept, that's not uncommon) and so my partner is the only paramedic on the scene.  However, in this county, the first on scene is person in charge, and it doesn't matter if they're an EMT Basic vs. a paramedic, it's first on scene is in charge.   So these yokels get all excited and call for the whirly bird to fly this kid.  Because of reported loss of consciousness.  Staff are saying she immediately got up when she fell, didn't even really hit her head, but this girl is in full on status dramaticus.  When everyone arrives, though, she's conscious, alert and oriented X4, GCS of 15.  Totally normal. Not even a bump on her head.  "BUT SHE LOST CONSCIOUSNESS!!!!!"  is what the fire guys are screaming.... "WE HAVE TO FLY HER!!!!!"

No, you just want to look important and land the heli-whop-whop in a field....  But my partner, even though he's got the most training, can't dissuade this guy (he seriously had a "respect my authoritah!" thing going)... My partner eventually just "whatever, your patient, your responsibility"....   So the helo is getting close, hotshot gives his patient report, and the nurse asks him to repeat the GCS....  "Fifteen" hotshot replies....  "FIFTEEN????" the nurse explodes.  "Whatever.  we'll see you on the ground in 3 minutes".  (For those not in the medical field, a GCS of 15 means no neurological deficits at all.  We don't fly trauma patients with a GCS of 15 unless they're missing a limb or have a penetrating trauma to the torso or similar....)

Hotshot is now starting to realize he screwed up.  Nurse climbs out of the helicopter, and starts getting wound up to blast my partner...  Since he's the only one with a Paramedic patch on his shoulder....  He just points at the firefighter who is now trying to blend in with the grass and hide behind the engine...   She marches over there, and even over the helicopter idling a couple hundred feet away, I can hear her yelling at him....

But the most disturbing part is that even knowing this patient most definitely didn't need a helicopter ride to the hospital, did they self-cancel and return to base, or just not take her once they'd landed?  Nope!  Loaded her up and gave her a very expensive taxi ride to the hospital.
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Brad Johnson

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Re: Facebook hospital screws everyone with private insurance
« Reply #10 on: January 08, 2019, 03:41:55 PM »

But the most disturbing part is that even knowing this patient most definitely didn't need a helicopter ride to the hospital, did they self-cancel and return to base, or just not take her once they'd landed?  Nope!  Loaded her up and gave her a very expensive taxi ride to the hospital.

Once the engines start, someone is getting a bill.

Brad
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MillCreek

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Re: Facebook hospital screws everyone with private insurance
« Reply #11 on: January 08, 2019, 03:54:25 PM »
In my emergency medical services journals, I read about enough EMS helicopter crashes to know that me and mine are not going to be loaded onto one unless it is truly lifesaving, as in cases of severe trauma or I really need to get to the cath lab or OR stat.  Several years back, we had an Airlift Northwest helicopter go down in Puget Sound with the loss of three crew and a pregnant woman in labor. It turns out it was not even an obstetrical/neonatal emergency and there was not an objective medical indication for air transport as opposed to ground.
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Quote from: Angel Eyes on August 09, 2018, 01:56:15 AM
You are one lousy risk manager.

AmbulanceDriver

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Re: Facebook hospital screws everyone with private insurance
« Reply #12 on: January 08, 2019, 06:31:51 PM »
Once the engines start, someone is getting a bill.

Brad

Our air ambulance provider locally will cancel right up to the point the skids touch the ground at the scene.  They like us to put them on standby (alerts the pilots and medical crew, they head to the bird and start pre-flighting it including engine start) for any potential call (in fact, one jurisdiction has a policy that any accident along a notoriously bad corridor they automatically put them on standby).  Unless they load the patient, no one gets billed.  But yeah.  They're not going to talk themselves out of a bill and/or tax deduction for the write-off.
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AmbulanceDriver

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Re: Facebook hospital screws everyone with private insurance
« Reply #13 on: January 08, 2019, 06:38:51 PM »
In my emergency medical services journals, I read about enough EMS helicopter crashes to know that me and mine are not going to be loaded onto one unless it is truly lifesaving, as in cases of severe trauma or I really need to get to the cath lab or OR stat.  Several years back, we had an Airlift Northwest helicopter go down in Puget Sound with the loss of three crew and a pregnant woman in labor. It turns out it was not even an obstetrical/neonatal emergency and there was not an objective medical indication for air transport as opposed to ground.

Our EMS Agency Medical Directors for the region are all of the mindset that, like code 3 driving, air ambulance use is a risk.  So we need to make sure the benefit outweighs the risk.
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BlueStarLizzard

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Re: Facebook hospital screws everyone with private insurance
« Reply #14 on: January 08, 2019, 06:46:43 PM »
How is this not going to backfire on the hospital? Eventually they are going to have enough of these patients filing for bankruptcy and just not paying.

And, IMHO, this *is* actually one of those things that should be illegal. Capped prices on emergency services and automatic insurance coverage should be required of any emergency trauma center that's going to get unconscious or semi conscious patients brought in by first responders.
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Cliffh

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Re: Facebook hospital screws everyone with private insurance
« Reply #15 on: January 09, 2019, 12:09:30 AM »
In my emergency medical services journals, I read about enough EMS helicopter crashes to know that me and mine are not going to be loaded onto one unless it is truly lifesaving, as in cases of severe trauma or I really need to get to the cath lab or OR stat.  Several years back, we had an Airlift Northwest helicopter go down in Puget Sound with the loss of three crew and a pregnant woman in labor. It turns out it was not even an obstetrical/neonatal emergency and there was not an objective medical indication for air transport as opposed to ground.

When youngest son got out of the Army (helicopter crew chief/mech) he went to work for an air ambulance company.  He quit after less than a year - he didn't want to end up being the last one to have worked on one of the choppers before it crashed.  Lack of proper maintenance was common where he was working.

Hawkmoon

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Re: Facebook hospital screws everyone with private insurance
« Reply #16 on: January 09, 2019, 12:33:17 AM »

But the most disturbing part is that even knowing this patient most definitely didn't need a helicopter ride to the hospital, did they self-cancel and return to base, or just not take her once they'd landed?  Nope!  Loaded her up and gave her a very expensive taxi ride to the hospital.

Maybe after Daddy got the bill the young lady got a come-to-Jesus lecture about not being a drama queen.
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Firethorn

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Re: Facebook hospital screws everyone with private insurance
« Reply #17 on: January 09, 2019, 10:17:22 AM »
And, IMHO, this *is* actually one of those things that should be illegal. Capped prices on emergency services and automatic insurance coverage should be required of any emergency trauma center that's going to get unconscious or semi conscious patients brought in by first responders.

Indeed.  Well, I think that any service where they can't tell you the price up front should be capped at reasonable rates.

Boomhauer

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Re: Facebook hospital screws everyone with private insurance
« Reply #18 on: January 09, 2019, 11:57:58 AM »
I have personally seen a helicopter land on my airstrip, load up the patient, and fly them to a hospital 20 minutes (by air). From the time EMS arrived on the scene till the time patient was loaded and the helicopter lifted off was 2 hours. The county hospital is less than 20 minutes away by road. The major hospital they took the patient to is an hour drive.
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brimic

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Re: Facebook hospital screws everyone with private insurance
« Reply #19 on: January 09, 2019, 12:13:57 PM »
Sounds like they are using the reverse of "pay what you feel like" used in the past by a few Panera restaurants- as in "pay what we feel like you should pay"...in a sanctuary city where a large number of participants aren't going to pay anything.
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