My son was born last year. We had two insurance companies and accidentally filed with the wrong one as primary.

I used my hsa to pay the balance of about $800

9 months later, instead of refilling with the correct insurance company, they sent us a $20k bill.

After we called them and said, hey you know you should probably refill with the right company, they did. The insurance company declined because they took to long to refile.

The hospital never bothered to follow up and explain the situation until we called the insurance company ourselves and had them restart the process.

In the meantime our secondary insurance approved the part of the bill that was for my son, rather than my wife. The hospital sent me a new bill for $200 for their deductible.

From here, there was an extended game of back and forth where they'd send me a bill and I'd call and ask if they figured out the rest of the insurance and what happened to the HSA check we sent them. This went on for 13 months.

My son is now walking and this week they finally sent us to collections.

I called and threatened to take them to court, and finally talked to a supervisor who admitted that they owed us $600.

But what about collections?

Sir, that was a different bill.

Why can't you take the money that you owe me and pay the bill that you just sent me to collections for?

Well you didn't ask us to do that. I'll go ahead and do that now.

I resisted throwing my phone through a wall just barely.

This describes the whole craziness well. How is a regular person supposed to be able to figure all this stuff out?

To quote from my own comment when we discussed this six months ago (replying to https://news.ycombinator.com/item?id=13325022):

"[…] there's adverse selection. The hospitals that make errors in the client's favor or that don't make errors at all are more likely to go out of business than the ones that make errors in their own favor. So guess which ones are still around when you need a hospital. In other words, just because the errors are accidental, it doesn't mean they happen at random. (This argument applies to any shady business practice that "looks" like an accident, for example dark patterns on websites, or having great customer service for taking your money but terrible customer service for refunding it.)"

That's not a complete explanation, as it would likewise prove that every business errs as much as possible in their favor. It wouldn't explain what's different about hospitals and health insurance that makes them so brutal about it.

True. My assumption is that there's a complete lack of the usual consumer protections because (a) no ability to shop around and (b) no political will to fix it because most bills go to insurance companies who (i) are expert at questioning medical bills and (ii) have a negotiated relationship with providers so they don't pay sticker price anyway.

Right -- those factors would be more relevant, specific things to point to than "providers who err in their favor get more money than those who don't".

Agreed on the scam. The way to handle this is to not pay, and send a letter claiming that you don't owe it. If they send it to collections you can sue for collecting a debt not owed. If a collector contacts you about debts they know or should have known are disputed then you can also collect statutory damages from those people. If they report to credit rating agencies, and you dispute the facts with them and they take more than a month to resolve the issue you can also sue those agencies, and you have fresh grounds for suing the debt collector as well. You may be awarded treble damages!

This is an amusing pastime if you can afford temporary depressions in your credit score.

Healthcare in the USA is not a scam, it's simply a for-profit business. They have worked extremely hard to maximize those profits for decades.

They're actually good at it, and it were a startup extracting those profits they would be applauded for it.

I think most startups that repeatedly charge their customers for services not provided would be out of business quickly.

but you have to also take into account that a lot of people don't pay (charity care)

Fraud perpetrated against some Customers is not a remedy for non-payment by others.

Some non payment is also considered bad debt (they expect the patient to pay, the patient doesn't pay). With charity care, the bill is explicitly forgiven.

The hospital industry claims non payments total around 6% of hospital expenses.

http://www.modernhealthcare.com/article/20120106/BLOGS01/301...

I do wonder if they calculate that 6% on what they bill though, rather than on what things actually cost. The margin on an unpaid bill isn't really a cost.

I remember reading that the 6% are from the billed prices, not the cost. The same when they claim to do things for poor people. They do a few procedures for free and claim the billed price so they can have nice PR for cheap.

Also for tax reasons, although different hospitals have different tax classifications.

No you don't.

This doesn't justify billing mistakes.

in reality that's covered by the price gouging and the hospital getting to write it off