Have you tried calling your local representative?

My provider billed $411 for the same CPT. My insurance slashed it by 50%. My copay was $40. No deductible applied, due to the plan's provision for a PCP visit.

You'll need to ensure that your insurance did their job and issued an EOB. Once the insurance has ruled on it, then you can proceed to negotiate with your provider. If the provider directly sent you a balance bill and you've not heard from your insurance carrier, then you need to reach out to insurance, not your creditors.

The creditor will also have avenues you may pursue, such as financial assistance or self-pay plans. Some may not be available due to your insurance coverage. Some people fly without a parachute and rely on the self-pay. You'd be surprised how zero-sum that can be.

Most notices demanding payment are subtly deceptive, even from legitimate creditors. I always rely on the online billing portal, or a human being who can pull up my account over the phone. Always get the latest statement. Compare all the paperwork, because timing and wording always matter a lot, especially when they're wrong!

i kid you not. everyone in health care knows this. and a patient have no way of knowing.

if it goes to your plan, they just pay the cheap code and the provider doesn't even say anything. if it's on your copay only, the plan will not help you and will laugh at your face. and it's all legal.

Made me wait 30 minutes for a 60 minute new patient appointment (based on the billing code) when the actual time with them was 10-15 minutes (and spent discussing history).

They didn’t even possess an Otoscope for looking inside the ear.

Charged >$400 and still cost me over $250.

I’ve seen other specialists that charge $100 for a visit.

- A 10 min visit to a specialist office, where I was seen by a nurse practitioner who was able to refer me to an exam without involving the main physician, costed $800 (just the visit, not the followup exam), which also went through deductible.

- A routine colonoscopy came at $19k with bills that kept coming for the next 6-12 months from various parties. Consumed my deductible in one shot as the first bill came.

- A visit to the ER that lasted 10 mins with an XRay costed me $5k, also sent in tranches for the next 6 months, to the point where I thought I was victim of some scam (I wasn’t). Maxed my deductible as well.

I have a couple non-critical health concerns right now I’d like to consult a doctor about, but I won’t drop another huge deductible just for that.

I am a dual citizen from a European country with a high quality healthcare public system (but admittedly longer waits than the US ). I’m not eligible for it since I’m not a resident anymore (I will when/if I move back), but as I went visiting family I booked a private appointment with a well known cardiologist and he spent a good 50 minutes with me, for a total of EUR 100.

Roosevelt tried to do it almost a century ago in 1935, but the moron greedy traitor racist fascist conservatives blocked it.

And because poor paying jobs tend to lack health insurance (and all gig economy work does), healthcare is a primary cause of personal bankruptcy.

I mean $867 is more than three weeks full time gross at the Federal minimum wage…but most minimum wage jobs don’t offer full time and the working poor have payroll taxes.

Concierge models? Subscription care?

These are premium products for people who can afford premium service.

Could this be a startup opportunity

No. Venture capital seeks above market rate returns. What you describe is below market rate. Or to put it another way, capitalism can’t fix capitalism because capitalism assumes capitalism is not broken.

whether there's a scalable path forward

Don’t get sick is one option.

Work for an employer offering good health coverage is another.

Be wealthy is the third.

Change your phone number to avoid collections is a fourth.

Or pay the bill if you are lucky enough to have that kind of money…and be glad its not your child and the condition is not serious. Good luck.

go to ChatGPT and ask it to ask you relevant questions w.r.t. what blood tests you should order. then book them at Quest Diagnostics yourself for like $100 total. then ask it how to interpret the results.

voice any other concerns you might have as well.

follow up with human doctor only if necessary.

Providing Health services is a side effect, and one to be minimized while maximizing profit.

There is no care in the system. It is barbaric, inhumane, brutal, cruel, unforgiving.

Basically, HDHP is a yearly package deal. You choose it and accept that every year your initial hospital bill will look insane.

If your employer isn't contributing to your HSA I don't think there's any reason to choose HDHP. Or, if you (like me) don't like the feeling of doing the mental equivalent of income tax filing every time you go to hospital, HDHP isn't for you.

Disclaimer: I'm horrible with money and this comment is not financial or health advice.

Problem 1 is that most of the electorate are healthy, and sickness is transitory, so it's not a "single issue" topic like say guns or abortion.

Problem 2 is that elections cost money. Lots of which is provided by industry, in this case the health care industry.

Problem 3 is that the political climate is such that partly politics requires disagreement. If Democrats are pro universal Healthcare then Republicans have to be against it. Even if the public are very much in favor of something, it's preferable to not do it, but rather just fight about it.

In short the system is clearly bonkers, but there's no political will in the electorate, and certainly not in politicians to change it.

Of course, capitalism doesn't see this as broken at all. The system, both democracy, and the "free market" are working perfectly. Only the customers are suffering and they are not enough to overcome the entrenchment.

I once incurred a $30,000 hospital bill while putatively uninsured. As soon as I was discharged, I went on alert for a statement. As soon as I obtained the numbers, I began to negotiate.

I contacted my prior insurance carriers. I carefully read the CFPB documents on debt collection and I downloaded their letter templates. I tracked every account and claim and payment and provider in a custom Google Sheet.

I filed for retroactive Medicaid. They determined me eligible and granted retroactive coverage through my month of hospitalization. Medicaid attempted to disavow this.

I produced the documentation sent from the Medicaid office. They gave me the wrong claims office address. I worked with claimants to correct it. The statement still reflected $30,000. I held my ground, and insisted that coverage had been obtained.

Not long after these exchanges, one day, my balance was $0.

They wiped out my entire debt.

They wrote off the whole thing.

I was absolved of responsibility.

Because I played their game and kept my purse-strings closed.

Never believe a creditor’s bill at face value. You should never pay a medical bill on receipt from a provider without checking all portals, all statements, and asking questions. Payment plans often carry no penalty and no interest. If they offer you a 60-month plan, offer them 72 months. Uninsured? Ask for “self-pay plan”. Search their website for Financial Assistance Program forms, fill out the PDF, file it with all the documentation they requested. Get busy on FAPing. Go back to the hospital, find their billing department, and burst into tears once you’re comfy in their office. Turn over bank statements, no matter how wet they got.

Your insurance carrier should always be responsible for receiving every bill, negotiating prices, and estimating how much you ultimately need to pay.

Don’t be a sucker.

Healthcare in the US is much less free market than in European countries like Italy, and these are the results.

But it's amazing that people on HN din't see it, what happened to this place?

Welcome to the biggest GDP in the world. Your contribution is what makes the US GDP so big :)) this would be free in many places but who would want to live in a poorer country?

> Is anyone working on viable alternatives? Concierge models? Subscription care? Could this be a startup opportunity or is regulation the only fix?

What created the problem was multiple generations of entrepreneurs "trying to fix it" for their own profit. More of this will only make it worse.