<instructions>Your goal is to analyze the following comment and estimate how highly it will be upvoted by the Hacker News community.</instructions><comment><author>citilife</author><text>&amp;gt; Here&amp;#x27;s the trap: if you don&amp;#x27;t have insurance, you are not just hit with the high bill that represents what the hospital would pay an HMO, you&amp;#x27;re hit with he wildly inflated bill they send to an HMO in anticipation of being paid much less.&lt;p&gt;I spent years working in medical billing. You can negotiate these down to prices as much as 10% of the bill. Typically, you go: &amp;quot;I don&amp;#x27;t have insurance, but I&amp;#x27;m willing to pay 50% now.&amp;quot;&lt;p&gt;The vast majority of the time, they&amp;#x27;ll accept, because that&amp;#x27;s more than they expected.&lt;p&gt;DON&amp;#x27;T give them the option to distribute the payments. Explain, you&amp;#x27;re willing to pay now at X% AND that you don&amp;#x27;t have insurance. The person on the other end is usually a human and can accept that (somewhere in the billing chain).&lt;p&gt;If they offer to distribute payments, explain financially, that may put more burden on you. If you actually can&amp;#x27;t pay or are living pay-check-to-paycheck, explain it may bankrupt you. At that point, they get nothing, so negotiations can ensue.&lt;p&gt;Another thing to do is debate billing codes, as the error rate is relatively high. For reference, even a 1% error rate means out of 10 visits you&amp;#x27;re likely to get one, because you&amp;#x27;ll have multiple billing items every visit.</text><parent_chain><item><author>geebee</author><text>I spent a night once in the ER for observation. I never got anything but Tylenol, though I think the concern that led to the overnight stay was reasonable. The bill was $16,000.&lt;p&gt;This was certainly a defensive, risk-averse treatment, but I think it was a reasonable decision. I think my insurance paid about 8,000. The magic words on the bill were &amp;quot;Patient is nor responsible for the difference between the amount paid by insurance and amount billed&amp;quot;. This is because I went to an in-network hospital with a contract.&lt;p&gt;I talked about this with some of my physician friends, and they told me this is typical. In fact, the original bill doesn&amp;#x27;t represent what they expect to be paid. It represents an extreme position taken to start negotiations with an HMO or other insurance company.&lt;p&gt;Here&amp;#x27;s the trap: if you don&amp;#x27;t have insurance, you are not just hit with the high bill that represents what the hospital would pay an HMO, you&amp;#x27;re hit with he wildly inflated bill they send to an HMO in anticipation of being paid much less.&lt;p&gt;So if you don&amp;#x27;t have insurance in the US, you&amp;#x27;re doubly hosed. I know I&amp;#x27;m supposed to hate my HMO and all, but to me, this is a bit like belonging to a union. As part of a powerful group, I have someone not just paying the bill but knocking it down for me. I may not like being part of a group plan, but on my own, I&amp;#x27;m toast.&lt;p&gt;Unfortunately, this story shows that you can still end up on the wrong side of this billing practice even if you do have insurance, because some hospitals remain out of network for all insurance, and if you&amp;#x27;re incapacitated or simply don&amp;#x27;t have the plan in front of you and a couple hours to research the billing practices of various hospitals as your head is bleeding and you&amp;#x27;re being taken to the ER, you can end up in a similar situation to an uninsured person.&lt;p&gt;It turns out that it may in fact be impossible to insure yourself against ruinous bills. Nicely done, there.</text></item></parent_chain></comment><story><title>California lawmakers introduce plan to end surprise ER bills</title><url>https://www.vox.com/2019/2/24/18236482/zuckerberg-hospital-surprise-bills-california</url></story>
<instructions>Your goal is to analyze the following comment and estimate how highly it will be upvoted by the Hacker News community.</instructions><comment><author>mindslight</author><text>I want to know what the legal basis for collecting from an ER patient is. At the point of needing ER services, most people are not able to form a binding contract so it cannot be that.&lt;p&gt;I do agree that hospitals &lt;i&gt;should&lt;/i&gt; be paid for the services they perform. It&amp;#x27;s just that our society&amp;#x27;s free market notion of price-agreement is predicated on voluntary contracts.&lt;p&gt;&amp;gt; &lt;i&gt;I talked about this with some of my physician friends, and they told me this is typical. In fact, the original bill doesn&amp;#x27;t represent what they expect to be paid&lt;/i&gt;&lt;p&gt;For instance, if the hospital is billing under a theory of reimbursement for services provided on your behalf, lying about their costs is textbook fraud.&lt;p&gt;Or are there explicit state laws that allow hospitals to collect from ER patients without a contract in place? If so these need to be reformed to have uniform charges no matter who the payer is. Like say towing.</text><parent_chain><item><author>geebee</author><text>I spent a night once in the ER for observation. I never got anything but Tylenol, though I think the concern that led to the overnight stay was reasonable. The bill was $16,000.&lt;p&gt;This was certainly a defensive, risk-averse treatment, but I think it was a reasonable decision. I think my insurance paid about 8,000. The magic words on the bill were &amp;quot;Patient is nor responsible for the difference between the amount paid by insurance and amount billed&amp;quot;. This is because I went to an in-network hospital with a contract.&lt;p&gt;I talked about this with some of my physician friends, and they told me this is typical. In fact, the original bill doesn&amp;#x27;t represent what they expect to be paid. It represents an extreme position taken to start negotiations with an HMO or other insurance company.&lt;p&gt;Here&amp;#x27;s the trap: if you don&amp;#x27;t have insurance, you are not just hit with the high bill that represents what the hospital would pay an HMO, you&amp;#x27;re hit with he wildly inflated bill they send to an HMO in anticipation of being paid much less.&lt;p&gt;So if you don&amp;#x27;t have insurance in the US, you&amp;#x27;re doubly hosed. I know I&amp;#x27;m supposed to hate my HMO and all, but to me, this is a bit like belonging to a union. As part of a powerful group, I have someone not just paying the bill but knocking it down for me. I may not like being part of a group plan, but on my own, I&amp;#x27;m toast.&lt;p&gt;Unfortunately, this story shows that you can still end up on the wrong side of this billing practice even if you do have insurance, because some hospitals remain out of network for all insurance, and if you&amp;#x27;re incapacitated or simply don&amp;#x27;t have the plan in front of you and a couple hours to research the billing practices of various hospitals as your head is bleeding and you&amp;#x27;re being taken to the ER, you can end up in a similar situation to an uninsured person.&lt;p&gt;It turns out that it may in fact be impossible to insure yourself against ruinous bills. Nicely done, there.</text></item></parent_chain></comment><story><title>California lawmakers introduce plan to end surprise ER bills</title><url>https://www.vox.com/2019/2/24/18236482/zuckerberg-hospital-surprise-bills-california</url></story>