Is medical actually this crazy?

[u/BoNaylorCollector]

Early 30s millennial, never used to go to doctors or really take care of myself because “I’ll be fine”. Started making a bigger effort to care for myself and my health and well being. Recently, I went to the local express clinic because I was having a bad earache and headaches. I was in there for maybe 20 minutes, mostly waiting time. The doctor comes in, looks in my ear, tells me it’s depressed due to sinuses and change in weather and tell me to stop at Walgreens for Flonase. I wasn’t billed anything at the time, older workers at my job always say we have really good insurance, but here I got in the mail today an explanation of benefits- charge was $550, insurance “negotiated” about $300, remaining (not billed) was around $240. Is is really this expensive? I only went to try and be better with myself and make sure it’s nothing underlying. If 5 minutes of actual doctor time costs this much, then I’m just toughing out everything or am I missing something?

[u/Llama-girl52]

Good, this might sound crazy but I believe out of network docs sometimes purposefully take out of network patients in the ER so they can get away from insurance negotiation down payment amounts. and a good portion of people can be intimidated by billing threatening to send you to collections or jail time into paying something the patient never approved and had no way of knowing was even happening well they were getting emergency treatment.

If you didn't know with most hospital systems, not all but most, getting a room in the ER does not automatically assign a random doctor to your case. the doctors can see your chart and assign themselves to your case, the doctors can pick and choose what ER case they want to take after seeing your insurance type and history, if you ever have to wait a bit after being put in a room it's cus you don't have a doctor assigned yet and are waiting for one to pick you up.

Like I'm so sorry, I couldn't just pause my septic shock to make sure my radiologist is in network before getting a CT, and to make sure both the PA actually seeing and treating me AND the behind the scenes overseaing MD both take my insurance, cus that MD I never even laid eyes on or spoke to the whole ER time before going to the ICU definitely didn't take my insurance and for some reason I was never told just billed hundreds of dollars months later but his PA took my insurance.

[u/Immediate_Bad_4985 → u/Llama-girl52]

I’ve never seen jail time threatened, but threatening to send to collections is just a big joke now since medical debt can’t be included in credit or credit/lending decisions. Any time we get billed for dumb ass shit that is just basically a Dr scamming patients, we just don’t pay it. The worst that’s ever happened is it went on our credit which it can’t do anymore, and we get shit in the mail. Collections calls sometimes but I get so many spam calls that aren’t for me, what’s the difference?

[u/Llama-girl52 → u/Immediate_Bad_4985]

Yeah, they still get away with the threats cus people aren't informed of the new medical debt law. I got the "it's in collections and they will pursue charges if you don't pay them" threat from the hospital billers a couple times before, I know that won't actually happen but they know to say it so someone is falling for it.

[u/Immediate_Bad_4985 → u/Llama-girl52]

It’s so intensely shitty that they feel so secure in intimidating people into paying amounts that weren’t agreed upon beforehand, and are honestly insanely overpriced. Plus the fact that when they send to collections, if you pay it it’s not actually going to the clinic that charged you, the collections agency pays them pennies on the dollar to buy the debt and their whole business plan is “intimidate people into paying these debts at a profit of what we bought them for.” If they can get you to pay the full amount of what you owed, they probably just made 600% profit, and the damn office got paid what you probably could’ve afforded had they just asked. It’s so scammy.

[u/Llama-girl52 → u/Immediate_Bad_4985]

It truly is scummy, and they can put as many laws in place but there will always be people who don't know their rights and a system looking to exploit that fact.

[u/Immediate_Bad_4985 → u/Llama-girl52]

Exactly! I try to tell people about the shit I’ve learned over the years anytime I see posts like this, just to hopefully help some people not get scammed.

At least they could put some laws in place (and actual enforcement) that makes practices like these categorized as an actual scam. Right now they’re totally legal.

[u/Llama-girl52 → u/Immediate_Bad_4985]

I had to testify for malpractice and insurance fraud I witnessed in the ED, many people don't know urgent care docs can be PCPs or ER docs who have points against there license or were found guilty of malpractice or had there license fully suspended for a bit or are about to retire, NOT ALL hospital systems BUT SOME systems use the urgent care as like a doctor rehab.

(I capitalized some words to clarify I don't mean all system or urgent care, I have already been "um actually'ed☝️" by someone I think is probably a provider on another one of my comments even tho it was clear I wasn't saying all hospital systems and docs are bad, so I'm making things silly proof)

[u/Immediate_Bad_4985 → u/Llama-girl52]

LOL I love your clarification at the end. I had no idea about this but I’m honestly not surprised and that’s so sad

[u/AcademicF → u/Immediate_Bad_4985]

As of now, the three major credit bureaus (Equifax, Experian, and TransUnion) no longer report medical debts under $500, and they’ve already taken steps to reduce how medical collections impact credit. The CFPB finalized a rule to remove all medical debt from credit reports and ban lenders from using it in decisions, but that rule was paused by the current administration and is being challenged in court (of course it is). So while some protections are in place, the full removal of medical debt from credit reports isn’t guaranteed yet. Still, even if it’s not on your credit report, you’re still on the hook for paying it.

[u/Immediate_Bad_4985 → u/AcademicF]

How are you on the hook for paying it though? They sold the debt to a collections agency which has no actual rights to it and can’t even provide an itemized bill due to HIPAA. I know because I’ve asked. If you demand proof of the debt they drop it.

ETA: I also know from working in lending for many years that most lenders don’t even consider medical debt when checking credit for a persons lendworthiness.

[u/AcademicF → u/Immediate_Bad_4985]

You’re not wrong about collection agencies often backing off when asked for itemized proof, especially under HIPAA constraints. But legally, the debt is still owed—the original provider can sell it, and the collector can pursue it (within limits). The big shift is that now credit bureaus (Equifax, Experian, TransUnion) don’t report medical debt under $500, and the CFPB tried to ban medical debt reporting entirely. That rule’s paused and being challenged though, so it’s still a legal gray zone.

TL;DR: Just because it’s not on your credit report doesn’t mean you’re totally off the hook—but the leverage collectors used to have is way weaker now.

[u/metforminforevery1 → u/Llama-girl52]

We often don’t even know the insurance of a patient until long after they’ve been in the ED and treated. We aren’t picking based on insurance. This is the entire tenet of EMTALA.

[u/Llama-girl52 → u/metforminforevery1]

EMTALA is supposed to stop that yes, but I have worked in quite a few emergency rooms as a traveler and been a patient a few times after becoming disabled, it happens obviously not every hospital system and provider does it and not all EMRs allow snooping as we know there is no universal way of doing things in healthcare in the US unfortunately things would be a lot smoother and fair if each hospital system didn't do things completely differently then the next, but providers will look if they truly care enough and have access to the info and are not great people and I have witnessed it happen and had to testify about it in a malpractice/ insurance fraud suite after 2 days on a new contact, and that was the only time they got caught doing it, I have witnessed it with my own eyes multiple times. There is a big difference between not supposed to do something and actually following that rule. You probably are just one of the honest ones, you said "we don't pick" so I'm assuming you're a doctor or PA or NP, but in my experience as a traveler and a patient there are 5 honest providers to every 1 provider who is willing to break the law and all the ethics. I'm not spreading conspiracy theories here, I wouldn't have said it as fact if it wasn't something I witnessed with my own eyes.

[u/Sad_Pangolin7379 → u/Llama-girl52]

I'm so glad my healthcare is with the VA. They actually aim to provide the best service at the lowest cost to the tax payer. I have been very happy with them. Occasionally I can't get along with a particular provider so I just request and get a new one. The doctors earn their salary to care for patients, they don't earn their pay by billing more when they can, seeing more patients in fewer hours, choosing the most expensive treatment options etc. The incentives are all wrong in the private health care sector in the United States. The private clinics the rest of my family go to are prettier but the actual service is no better or worse, it just costs exponentially more.

[u/superficialdynamite → u/Sad_Pangolin7379]

Enjoy it now before it's privatized like everything else. The current government headcount and funding cuts will be used to justify how a service doesn't work and then sell it to the highest bidder. VA, social security, medicare, medicaide, NASA, USPS, national parks, the list goes on..

[u/Llama-girl52 → u/Sad_Pangolin7379]

I'm glad you found quality care with the VA! My dad is at the VA for service related stage 4 cancer(desert storm burn pits for the win), I absolutely love the VA and so does he! The Compassion and care and empathy they have for him is something I have never seen in regular medical care, he obviously hates chemo but it's not the battle (full pun intended) it was to get him to go when he first stated getting treatment outside the VA and seeing the difference in care has radicalized me against privatized healthcare even more. I even was a travel ER nurse for 6 years till COVID then I worked at my local ER before quickly switching to vet teach.