Happy New Year!
Do you have a dumb question that you're kind of embarrassed to ask in the main thread? Is there something you're just not sure about?
This is your opportunity to ask questions. No question too simple or too silly.
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Notes -
I had to visit the emergency room earlier this year for a nose bleed. At the time I was discharged (October 2022) I paid a 200$ bill to the hospital, foolishly believing that this was the entire cost of the visit. I subsequently received a 357$ physicians statement. This little episode in medical billing really irritated me since I felt that the hospital had hidden the actual cost of their services and because the amount was absurd for the services rendered (10 minutes for a physicians assistant to apply some topical TCX). As a result I have been thinking of not paying it and am trying to understand if recent changes to that the credit reporting agencies have made may allow me to get away with this without damaging my >800 credit score.
In particular it sounds like medical debts < 500$ will no longer impact a credit score starting in 2023 https://www.equifax.com/personal/education/credit/score/can-medical-debt-impact-credit-scores/ and I am trying to determine if this determination is made based on the date of the service(s) (october 2022) or the date that a bill is sold to a collections entity, which could occur in late January. I also discovered that paid medical debt collections haven't impacted a consumers credit score since 2022 (https://investor.equifax.com/news-events/press-releases/detail/1222/equifax-experian-and-transunion-support-u-s-consumers), so its my understanding that even if they are able to sell this bill to a collections entity, the worst that could happen is that I would simply have to pay the amount at a later time.
Does anyone know if this analysis is basically correct? Its my understanding that their only other recourse would be to try and sue me which is unlikely to happen over a 357$ bill.
You should get insurance, this is what it is for. If you have a plan but it has a super annoying deductible....well yes that's how it works (if you don't and you were cash pay you should call the billing department as the other user pointed out, and then get insurance).
I'm not sure if this will help but you should consider that (while it may appear superficially similar) medicine is not going to be like going to a mechanic. When you go to your dealership the work of analysis and diagnosis is often not paid for, then they'll tell you how much it is to fix the issue and you can take it or leave it. The cost is the labor and parts and replacement and repair. When you go to the emergency room you are paying the staff for the time and resources it takes to figure out what is going on. The treatment is often cheap (medicine, a splint, whatever) but the imaging, labs, and professional fees are time consuming and expensive. As a layman you aren't going to know what is going on under the hood (for instance in this case adults generally don't get nosebleeds that are bad enough to bring them to the hospital, so it could be because it's hella cold and dry outside, or it could be because the patient is having issues with clotting blah blah).
If you have chest pain and go to the ER, and after talking to you they give you tums and tell you to avoid spicy food the bill isn't for the tums it's for making sure you didn't have a heart attack.
You can see my responses below if you are interested in more details but I fundamentally don’t feel any moral obligation to a system where you have in network hospitals with out of network doctors.
Also it’s sort of stunning that americas credit bureaus appear to agree that the system is so exploitative that they simply ignore small
Amounts of medical debt when considering my probability of repaying other debt.
Do you believe health systems should be forced to provide care for someone who has no willingness and/or ability to pay? (They are - if you walk into an emergency room and say I will not pay for any care you provide me they are legally required to give you the same shit as anyone else).
If your response is "you know what I don't want any medical care" then my complaint is withdrawn, but otherwise it sounds like you want to "steal" because you don't like how the process works and don't have a lot of information about healthcare economics.*
*From your other post it sounds like you've been on the receiving end of a practice called surprise billing, which is controversial and legislated against in some jurisdictions but exists for a complicated and justifiable reason but is still annoying, as is usual the problem is health insurance companies being pretty much straight up evil and then blaming everyone else.
As for your frustration with medical debt, if people refuse to pay their medical bills all the hospitals go under and nobody gets medical care. I can understand you're frustrated but these things exist for a reason.
They lobbied to make it illegal for anyone outside their club to provide medical care and then they charge an arm and a leg for it. If they didn't require 10 years of school to fix a nosebleed then it wouldn't be this bad.
I'm going to be a bit fiery here because this comment is top to bottom incorrect. It will never cease to amaze me how strong opinions on healthcare are with no experience, knowledge, or accuracy.
The minimum amount (with room for a lot a lot more) of training for a physician to practice independently in the U.S. is 11 years (4+4+3), there are some exceptions but they are very rare.
The person caring for OP who they are complaining about is a provider (a PA), not a doctor, and has a minimum (and essentially maximum) amount of training of 7 (4+3) years.
Physician lobbying groups have spent the last 15-20 years heavily lobbying for people outside their "club" to able to provide healthcare (providers), because they could charge for it in a supervisory capacity. Now it's biting them in the ass because those providers are lobbying for independent care, providing inferior and infuriating care (often while identifying themselves as doctors) and increasing costs (PA/NP care costs more but it's in stuff that the hospital/ownership group gets to take a bite out of instead of professional fees, for example unnecessary lab testing).
Fixing a nosebleed is harder than you think it is. A lot harder. A school nurse or a person at home can shove a tissue up your nose but that doesn't mean they are thinking about coagulopathy, and considering the risk of TSS, other infection, necrosis, know when to call ENT or to do a further work up and so on. Nasal packing for epistaxis is something requires a surprising amount of considering and critical thought, but you don't know that, the nurse doesn't know that, the PA probably doesn't know it, and an annoyingly large number of EM doctors don't know it. Ask a pediatrician.
Physician professional fees are a small portion of the cost of healthcare.
If I wanted to read 10k (or more) words to learn how to be less wrong about healthcare, where might I start?
(and yes I know you asked for a general primer but the point is to build knowledge of the unexpected complexity).
Here's an example-
https://old.reddit.com/r/Residency/comments/104bwb4/why_was_damar_hamlin_in_the_sicu_after_his/
Why is Damar in a SICU (Surgical Intensive Care Unit) - some people are saying that's best practice, some people are saying that's best quality of care, some people are saying that's because of the resources specifically at UC and some people are saying it is because the case is high profile. And you can find someone saying the opposite for each of those. Everybody knows what they are talking about.
No way to know unless you work there and were involved and some combination of those answers is probably correct.
Stuff is very resource and facility dependent and a lot of things don't have strong consensus.
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I learned how to effectively grade scientific literature by looking for places where you'd see the hordes of "SOMEONE IS SAYING SOMETHING WRONG ON THE INTERNET" types and seeing what they said, and then after years of that picking up the skills myself.
Go to /r/medicine or other similar places, look for the hot button stuff, see what people say and complain about. At first you'll be missing context but you'll pick it up. Bonus points if you also go to the other places with different levels of training like /r/residency.
Be aware of the biases of the various areas though (anything remotely political is DOA on meddit, it's appropriate to hate midlevels but the residency subreddit takes it a little far).
Very common for industry adjacent people to do this, you'll see consultants, tech people, and lawyers pop in with their expertise because they are following or work or because of a partner.
Most of the mistakes people make are pretty basic- assuming it's simple and easy, or because they are falling for one of the agenda pushers (including us).
If you look closely you'll probably see one of those situations where three people with over 20 years of training and who very are on top of it are articulately arguing over if something like if "is a bandaid is actually a good idea or not" and you'll be like Jesus this is a nightmare.
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You're incorrectly imagining that competition to the medical industry would take the form of a smaller less trained private healthcare industry that otherwise operates entirely the same as the current dysfunctional system. In reality it could be something like going into a clinic staffed by a couple of people with bachelors degrees who go through a digital flow chart and either refer you to a full hospital if the flow chart says it's beyond their capabilities, with an estimate of how much the hospital will charge so that you can be an informed consumer, or solve issue using a step by step guide that comes up immediately from the flow chart. This whole process could cost nearly nothing compared to going into a hospital and paying hundreds of dollars to waste an MD's time and be perfectly transparent.
And yes, the idea that you need over a decade of training to do the majority of what people are paying for in the healthcare industry is absurd and broken.
Just so so wrong. Even in other countries with faster tracking the thing that gets cut down is undergrad (which is fair but hard to do in America, has its own significant problems, and is logistically unfeasible without completely uprooting our system in a way that isn't happening, and only shaves off two years anyway). We have some good evidence for this in the highly limited care given by providers - the NP lobbying groups best data says that NPs outcomes in simple cases is about equal with physicians outcomes in complicated cases (of course they jazz it up but that's what their data says, never mind the MD studies). Keep in mind that doctors are also the only ones getting that much training, everyone else is considerably less....and it shows. Ask any psychiatrist off the record about how the NPs and PAs are doing and they'll be able to convince you to never send a loved one to either.
As for your other point, flow chart care just doesn't work, no matter how much the MBA types may want it to. Decision support tools are miles off, for some godforsaken reason you can replace artists with an "AI" but the EKG autoread (which is one of the most computationally simple tasks imaginable) would get people killed if put in charge.
In addition to the always underestimated medical complexity, you have the human element - patient entitlement these days is sky high (as exhibited in this thread), people are always demanding things that are not indicated or are outright bad for them (ex: antibiotics for viruses) and your flowchart clinic would be immediately going off the chart or burned down.
That's not taking into the account the unacceptability of failure and legal environment, as soon as someone dies because of an edge case (which happens all the time) flowchart clinic would get sued into oblivion.
If you accepted upfront that 10% of people are going to have an unnecessarily bad outcome and 1% of people are going to die unnecessarily you'd be able to do as you say, but nobody is signing up for that. We (rightly so) value human life too much for that.
Really? What are the numbers under the status quo?
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I'm married to one, she disagrees. Most of her beefs have been with the embarrassingly dysfunctional nature of the hospitals she's been in that would never stand if there was real competition. EDs that either have no way of checking how many bed the psych department has open or for some reason refuses to believe either those tools or the doctors who tell them they have no beds. Spending countless hours on hold with pharma companies because for some reason totally inconceivable to me you need multiple doctorates to navigate call trees. The pure waste of it all has had me furious more than a few times.
If by "unnecessarily bad outcomes" you mean their nose bleed takes longer to figure out then sure I think people would be more than happy to deal with that and save hundreds of dollars.
No way this is accurate.
Why yes, we're discussing the legal framework your lobbying group has been enmeshed in creating. "We'll crush your upstarts like the pathetic little bugs they are if they dare" is precisely the thing I'm arguing should be abolished.
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