Happy New Year!
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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.
"these things exist for a reason"
so what? whether something has a reason doesn't mean the reason is good or justifiable; you don't describe any of those reasons or justifications so there isn't anything to respond to here
trying to portray this as some sort of moral choice binary where you either never seek healthcare or you're stealing if you refuse to pay any bill any random biller in any random medical black box decides to send you empty moralizing and a bad argument
anyone who has legitimately tried to find out what services are going to cost in the medical industry knows how incredibly and intentionally dishonest and obfuscatory it is
lots of people refuse to pay their medical bills now (especially the full amount) and yet more healthcare is delivered now than ever before
the user isn't claiming no one should pay medical debts, but that at most people shouldn't pay ones which are the result of asinine practices intentionally designed for this outcome which is asinine
if more people refuse to abide by these asinine practices, then the practices would end not that no one would provide medical care to anyone else anymore as is the case in states and countries which ban this practice
If you have your car repaired and drive off without paying you are going to get reported, and you certainly don't get to come back and demand the next issue be fixed. It's absurd. Even in outpatient land you can't fire a patient (even with just cause like total refusal to pay or blatantly abusive behavior) without jumping through a ton of hoops.
Rural hospitals and suburban/urban hospitals with poor payor mix (in a lot of areas/for a lot of types of care medicare and medicaid pay less than cost) are going under left and right, and other places are closing their EDs in an attempt to stem the bleeding associated with most of the people least likely to pay. It's not getting a terribly large amount of attention outside the field because it's mostly poor whites and the media/left feels awkward about leaving healthcare out to hang after so much superficial support during the pandemic.
This specific practice (this explanation is abbreviated)* is driven by insurance companies refusing to negotiate with physician groups and just say lol I'm going to underpay you, fuck you. When providers try and negotiate the insurance companies label this "surprise billing" and lobby jurisdictions to ban, knowing that the result is professionals have to just not get paid or accept the lowball offer. It's a negotiating tactic. In the last few years providers and low resource health symptoms have seen total crashes in economic health while high resource systems and insurance companies are doing fantastic, but they don't replace the resources that are closing and retiring.
About half of the psychiatrists in the country are able to retire and they are just fucking right off instead of staying and during a time of sky rocketing mental health crisis. We have limited ability to train replacements if we even wanted to (for a number of reasons) and the stopgap (Psych NPs) are uniformly terrible and create more work for the leftover physicians (psychopharmacology is a lot more complicated than most management, as in diagnosis).
*Their are other explanations, you have stroke and the one neurologist on call doesn't take your insurance. Either they let you die, or work for free/try and bill your insurance anyway.
Fundamentally, it sounds like you perceive that the problem is that people don’t pay enough for health care (whether that is through private insurance or through Medicaid).
This means that the hospital/physician is trying to take advantage of me because I am easier to negotiate with than my insurance company or the government. In the recent past where they could fuck my credit score they had most of the leverage and this would have worked and people like me would have been responsible for propping up a broken payment system. How is this not absurdly predatory?
Now that this is more difficult perhaps the AMA or the hospital lobby or any number of absurdly powerful interest groups which exist to guarantee the welfare of the healthcare industry, can take action on this instead?
I suppose they might also just increase bills so they always meet the 500$ credit reporting threshold but this will probably take them a few years since it will need to at least look somewhat what organic to avoid being sued by some ambitious attorney general somewhere.
The hospital and provider/provider group are definitely not making decisions based off of some credit reporting threshold, they don't have the time or energy for it and charges and costs are too often pegged to other things. The insurance company might be, can't speak to that.
I also make no claims as to if people aren't paying enough, I just want people to actually pay like they said they would (especially in the case of the ED where 9/10 visits are inappropriate and make things more expensive for the people who actually need the ED resources).
Now is the government or insurance paying enough, that's a separate question. No for some aspects of healthcare, in a very demonstrable sense (that is, if your hospital is being paid mostly by medicaid it WILL go out of business without another funding source like being directly propped up by the state government).
Another different discussion is "are providers overpaid" and while that's a much more nuanced question, in a very practical sense the answer is no - if you want to see a specialist outpatient (especially in something like neurology) you are going to wait two months or have private insurance. The healthcare sector of the economy has been trying to slowly boil docs with decreasing salary for decades and it's starting to boil over and you just wont get good care (or care at all in some fields like psychiatry) if you aren't rich. I'd not be shocked if life saving surgery is simply not available within the next 10-15 years because surgeons will just refuse.
But in this case the issue is that you have a problem with the customer service and overall service offered to you by your insurance company, and you are taking it out on the health system. The problem is the health insurance product you purchased not giving you what you want (because of blah blah negotiating with what's probably a private equity owned practice management group with no clinicians in the leadership structure at all). At no point was anyone directly in healthcare involved in what fucked you except for the person who actually helped with the epistaxis.
Generally speaking health systems are very willing to negate with patients paying out of pocket because the charges are made up as part of some bullshit voodoo dance with insurance and the government. The unwillingness to negotiate def increases the likelihood of that professional fee going to a private equity group (the PA probably got paid like 50 bucks for 30-45 minutes of work that was mostly invisible to you).
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