I occasionally get random bills from "providers", and I think it shows just how awful medical billing is.

The worst was whenever we had our first child. I thought it would just be a single bill or something, but instead I received about 10.

One from the hospital, one from a surgeon, one from the OBGYN, and one from an anesthesiologist. We only met one pediatrician during our stay, but we received a bill from every pediatrician that did a rotation while we were there, so that added four more. One because a nurse working was an independent contractor, and one from the wet nurse who we talked to for like 5 minutes.

Two of them we never actually received bills for because they had an outdated address, so they were sent to collections. We discovered them a year later when we were trying to buy a house. It dinged my wife's credit so bad that we were recommended to not put her on our mortgage application.

"One from the hospital, one from a surgeon, one from the OBGYN, and one from an anesthesiologist. We only met one pediatrician during our stay, but we received a bill from every pediatrician that did a rotation while we were there, so that added four more. One because a nurse working was an independent contractor, and one from the wet nurse who we talked to for like 5 minutes."

This is it. This is the US medical scam crystallized. What you need to focus on as a US patient is the "Out-of-pocket maximum/limit." (a number) - which is the yearly maximum you pay as an insured person. Basically, once you enter into an ER you are going PAY this this number. This number is reset every January 1st. So If you have a child January 2nd -- you are in GOOD* shape -- since you will hit your yearly max ("Out-of-pocket maximum/limit.") early in the year -- all other medical is free.

My friends that had a child December 30th, are in bad shape. They pay for yearly "Out-of-pocket maximum/limit" two times: one for the current year and one for the next year.

Stories like this are what keep me as a Kaiser member. In the years I've been with them, I've been to the ER twice and have yet to hit the yearly maximum. Usually they correctly bill me while I am on-site, only rarely do they have a follow up bill.

My out-of-pocket maximum resets on July 1st. Found out after having a baby in late June...

"Hold on honey, it is nearly 12...". This is really terrible. Healthcare (and burial) should be free.

I got a notice from a debt collector and I disputed it. The proof they provided was a hand-written note from the doctor, and a copy of the hospital's form my wife signed (while in hard labor, mind you) agreeing to pay the hospital. But the hospital had no record of a doctor by that name and could not confirm the legitimacy of the bill. Neither could anyone at the contact address provided.

It ended up going to court and it was judged to be a legitimate bill that I had to pay. That's how bad the system is.

> It dinged my wife's credit so bad that we were recommended to not put her on our mortgage application.

I've been through this sort of thing, and it's ridiculous. Medical bills shouldn't be able to affect one's credit rating.

That's old school. The latest scam is for hospitals to buy up all the independent neighborhood clinics, and then double charging for services there. For the same service, the doctor at the clinic will charge their usual fee, then the hospital will charge another one for the privilege of hanging their name at the door -- it's called a "facility fee", because you see, by stepping in you've entered a "hospital" even though nothing has changed [1]. For a routine visit, as an example, you pay for the doctor's service and the use of their office. Did the doctor reduce their fee which used to cover such mundane cost of doing business as having an office? Ha! Of course no.

There is simply no end to the greed of the medical cartel hell bent on subverting market forces.

[1] https://www.the-alliance.org/uploadedfiles/Health_and_Wellne...

While we're sharing stories:

My wife was in a near-fatal traffic accident on 2015 (she was a pedestrian). She spent about a month in the hospital and a month in in-patient rehab. Extremely fortunate for us (and most importantly), she's made a 99% full recovery

She was insured, so that absorbed most of the $1M bill (though the insurance negotiated the bill from the hospital and rehab center to 400k somehow) associated with her care. Several months ago (i.e. 2 years later) we were informed that the insurance company had deemed my wife's last week in rehab "not medically necessary" and refused to pay the rehab center. So the rehab center responded by sending us a $26,000 bill. Due in 30 days lol.

The rehab center is the one who fixed her discharge date (we had no input) and it's not like we're in a position to determine when she's fit to facilitate her recovery on her own. The insurance company still refuses to pay after we called them.

So we're left with a) don't pay the bill and see what happens (credit score hit? Law suits?); b) hire attorneys that will likely cost about as much as the original bill; or c) pay?

Luckily my wife and I have the savings on hand to pay the bill without threatening our livelihood, but is there really no other options for us? How would the average American whose after-tax salary is ~30-40k deal with this?

Btw, if anyone has advice it would be much appreciated. We've talked to some attorneys about Option B but it's uncertain if the cost of retaining a lawyer would outweigh the size of the bill itself.

You can almost always get a free consultation from a lawyer. In that, they will make a guess as to how likely the case is to be won by you (the plaintiff) and decide whether to take it on or not.

It's possible to also have added to the judgement in your favour, coverage for any fees you've had to pay to retain counsel to take care of this legal matter for you.

I'm not sure if by "talked to some attorneys" means a casual chat with a lawyer friend over lunch, or if it means "requested a consultation to determine whether retaining an attorney is the best path forward based on A, B, C".

Call your state's bar association. They can't recommend a particular attorney, but they can generally point you to organizations that can help find the right attorney for you, particularly if cost is a factor.

Will it cost money? Definitely, up front. Will you get it back? Quite possibly.

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You will notice with most (probably all) things medically billable the amount the insurance company pays is lower that the billing amount, that is the insurance company's negotiated rate, setting that price is one of the central things insurance companies do.

The fact that the never-paid price ever reaches the patient in the form of a bill is the problem.

This isn't for lack of pricing data. Hospitals know what they've paid for procedures previously. Every patient and procedure is different but it's rarely very different.

If a hospital has to bill a patient without insurance, what they charge should be pegged to a historical average for the baseline procedure.

Forcing us to negotiate puts undue burden on the patient. It's bad enough I have to occasionally call to keep my prices the same for cable and phone services.

I can’t find it now but someone responded to one of these threads that is actually illegal to negotiate your bill except for hardship cases.

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What you have described -- a provider who does not try to collect the patient responsibility portion of a bill -- is actually insurance fraud (because the provider has told the insurer the total price for the procedure is $42k, when the provider actually only intends to collect $38k).

I'm not saying that means it didn't happen--things like this are incredibly common--but a reply suggesting you might not have described the full picture and it's possible there is no fraud is not completely out of line or an insult to your intelligence. (I upvoted your original comment, BTW.)

Actually many readers of HN outside of the US will not be that familiar with the peculiarities of the US system.

I'm American. I even worked in insurance for a few years.

I've been a military dependent my entire life first under my father, then under my husband. I've essentially never dealt with American medical insurance. The military system is basically a different medical system.

There are probably other Americans who don't really know how it works either.

I am always surprised that the "support the troops" Republicans inflict socialized health care on the military. You should think that they would want to liberate the poor soldiers to enjoy the freedom of the free health care market.

I'm not very political. I'm assuming that's sarcasm, but I don't really know. There are people who genuinely think the military medical system sucks, though I'm not one of them.

I was sarcastic. I just don't get how hypocritical it is to claim how bad socialized healthcare is while maintaining socialized healthcare for one of their favored groups (the military). I am sure the VA has its problems but I rarely hear a vet say they want to abolish the VA and enjoy the freedoms of the US healthcare market.

It's a little more complicated than that. Again, I'm not political. I just know a good bit about the military system.

The military needs its own medical assets so it can treat soldiers in times of war. For security purposes, it needs medical facilities and medical personnel under its own control. It isn't sufficient for there to be sufficient civilian facilities.

Military dependents get free medical care in part to keep doctors busy with real cases during peace time.

Military members and their dependents cannot file malpractice suits. There are people who are very unhappy with this fact. Mistakes do happen. When they happen, you don't have recourse to sue and this is a point of contention for some people.

They also have world class facilities. If something goes seriously wrong, you can get referred to one of their regional hospitals.

I'm alive in part because we happened to be stationed at a base with a regional hospital when things went badly sideways for me. It served military personnel in eight states. It was a teaching hospital with connections to UC-Davis Medical in Sacramento and, I think, Stanford in San Francisco. I had testing in both cities. I got a cutting edge diagnosis. That was a turning point in my life.

For the record, I think we need a single payer system in the US. The current civilian medical system is seriously broken.

The VA is seriously broken. Just look at how poorly they treat mental health care [1].

What's the point of having access to world class facilities during combat, if you're just left to fend for yourself when you return home?

[1]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5563010/