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Small-Scale Question Sunday for January 1, 2023

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.

Culture war topics are accepted, and proposals for a better intro post are appreciated.

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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.

  1. 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).

  2. 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.

Having read through this whole thread, I wanted to say that I consider myself a strict capitalist in most things, but the whole industry of medical billing is so ridiculous for so many inscrutable reasons with everyone pointing fingers at each other that I find I'm unwilling to make any moral judgements at all for anything any particular patient chooses to do.

It is indeed pretty incredible that the situation is seen as ridiculous universally enough that the credit bureaus are now ignoring medical debt.

I don't know that I'm inclined or qualified to really defend any particular party in this mess. But I do notice that everyone seems to love to make the insurance companies the boogiemen. Aren't they all publicly traded though? If they're wildly profitable, can I invest in them and get some of that sweet healthcare cheat money? If not, well where's all the money going? What if they're just struggling to eke out some tiny profit while being constrained by an ever-changing maze of legislation and trying to juggle the conflicting demands of a dozen different groups, as the sole party with some responsibility to actually make the books balance somehow with the totality of everything that's going on?

  1. Everyone has an opinion about healthcare, almost nobody expressing this opinion has the slightest idea what's going on and that often includes people in healthcare, often this is downstream of politics (ex: docs foaming at the mouth at anti-vaxxers, or advocating for "socialized" healthcare without knowing what that means) or arrogance (the "medicine isn't hard or complicated" crowd you see here frequently).

  2. Yes follow the money. Some high resource health systems are doing well, but many health systems are being bailed out or going under. Salaries are decreasing relative to inflation (or just overall), burnout is increasing and we've had a bunch of major major strikes/threats of strikes over poor pay and working conditions (like unsafe nursing staffing ratios). Meanwhile:

"The nation's largest insurers, UnitedHealth Group and Elevance Health, reported profits that were 28 percent and 7 percent higher than the same period last year, respectively. UnitedHealth raked in $5.3 billion, while Elevance took in $1.6 billion.

In contrast, some of the nation's largest health systems, HCA and Tenet, saw their profits fall dramatically compared to the third quarter of 2021. HCA reported $1.13 billion in profits, a decrease of 50 percent. Tenet took in $131 million, which is down 70 percent since last year."

Notably HCA and Tenet are both pretty evil companies (large for profit health systems) that will do WHATEVER to make a buck (and have been in legal trouble over it).

  1. Medical billing isn't "ridiculous" okay well it is, but it makes sense and is a well defined system that a lot of people don't understand... but again people don't understand it but everyone is forced to interact and therefore has opinions. Providers become the punching bag for appropriate medical decisions patients don't understand and administrative/billing decisions that providers have zero control or influence over (having being pushed out of medical leadership and admin for decades, sometimes by complicated government mandate).

  2. Speaking of which why is this shit so expensive? People like to blame salaries and labor shortages but that's a lack of understanding at best and jealousy at worst. Our population is getting less healthy (and other countries are catching up in costs as they become like us) and care is getting more complicated and expensive for good reasons. Additionally regulatory and administrative burden means lots of extra hands sucking at the teat. It's similar to academia (think professor to admin ratios, self-inflicted wounds like DEI staff etc).