# Trump executive order now requires transparency up-front in hospital billing **URL:** \ **Category:** Great Debates\ **Created:** [June 25, 2019, 2:09pm UTC](https://boards.straightdope.com/t/trump-executive-order-now-requires-transparency-up-front-in-hospital-billing/836033 "2019-06-25T14:09:15Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![Czarcasm](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/czarcasm/32/4050_2.png) [@Czarcasm](https://boards.straightdope.com/u/Czarcasm)\ **Post date:** [June 25, 2019, 7:18pm UTC](https://boards.straightdope.com/t/trump-executive-order-now-requires-transparency-up-front-in-hospital-billing/836033/21 "2019-06-25T19:18:58Z")
> [@Wesley\_Clark](#): > > Don’t talk down to me because you’re too neurotic to understand verbal nuance. I know what an executive order is. Your post made it sound like he signed a bill that was passed. If you meant something else other than what you said, you hid it well. ---
**Author:** ![scr4](https://avatars.discourse-cdn.com/v4/letter/s/59ef9b/32.png) [@scr4](https://boards.straightdope.com/u/scr4)\ **Post date:** [June 25, 2019, 7:21pm UTC](https://boards.straightdope.com/t/trump-executive-order-now-requires-transparency-up-front-in-hospital-billing/836033/22 "2019-06-25T19:21:11Z")
Wouldn’t this mean the hospital can’t do _anything_ until the insurance company decides whether to pay for it or not? ---
**Author:** ![Czarcasm](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/czarcasm/32/4050_2.png) [@Czarcasm](https://boards.straightdope.com/u/Czarcasm)\ **Post date:** [June 25, 2019, 7:24pm UTC](https://boards.straightdope.com/t/trump-executive-order-now-requires-transparency-up-front-in-hospital-billing/836033/23 "2019-06-25T19:24:47Z")
This is just Trump’s version of “We have top men working on it now. Who? Top. Men.” ---
**Author:** ![Ludovic](https://avatars.discourse-cdn.com/v4/letter/l/7ab992/32.png) [@Ludovic](https://boards.straightdope.com/u/Ludovic)\ **Post date:** [June 25, 2019, 7:25pm UTC](https://boards.straightdope.com/t/trump-executive-order-now-requires-transparency-up-front-in-hospital-billing/836033/24 "2019-06-25T19:25:07Z")
> [@Czarcasm](#): > > The plan to have Mexico pay for our drugs fell through. Well, by some meanings of those words, it’s true, given the recent reversal of the direction of traffic of a certain substance that was legalized in some states. ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [June 25, 2019, 7:35pm UTC](https://boards.straightdope.com/t/trump-executive-order-now-requires-transparency-up-front-in-hospital-billing/836033/25 "2019-06-25T19:35:09Z")
> [@Czarcasm](#): > > Your post made it sound like he signed a bill that was passed. If you meant something else other than what you said, you hid it well. Well, as was mentioned two words into the title, it was an executive order. ---
**Author:** ![Bone](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bone/32/407_2.png) [@Bone](https://boards.straightdope.com/u/Bone)\ **Post date:** [June 25, 2019, 7:40pm UTC](https://boards.straightdope.com/t/trump-executive-order-now-requires-transparency-up-front-in-hospital-billing/836033/26 "2019-06-25T19:40:38Z")
> [@Wesley\_Clark](#): > > Don’t talk down to me because you’re too neurotic to understand verbal nuance. I know what an executive order is. Dial it back. [/moderating] ---
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [June 25, 2019, 7:48pm UTC](https://boards.straightdope.com/t/trump-executive-order-now-requires-transparency-up-front-in-hospital-billing/836033/27 "2019-06-25T19:48:14Z")
> [@kayaker](#): > > Yes, getting a straight answer can be difficult, which is why I take it to a fanatical level. Don’t want to tell me what the blood test is going to cost me? Then I refuse to allow the draw. Eventually someone comes by to answer my original question. The works until you’re unconscious and in an emergency situation - then they just do stuff and you get the bill later. So while this might be a boon for _elective_ procedures it will do frack all for emergencies. ---
**Author:** ![Joey\_P](https://avatars.discourse-cdn.com/v4/letter/j/919ad9/32.png) [@Joey\_P](https://boards.straightdope.com/u/Joey_P)\ **Post date:** [June 25, 2019, 7:54pm UTC](https://boards.straightdope.com/t/trump-executive-order-now-requires-transparency-up-front-in-hospital-billing/836033/28 "2019-06-25T19:54:41Z")
> [@doreen](#): > > I feel like I’m misunderstanding something here - or was a matter of the ambulance out front not accepting your insurance and it was just a coincidence that the covered ambulance was based in your hometown ? I’d guess that either of the ambulance waiting for him wasn’t in his network but the one he called from home was OR the transfer from one place to the other wasn’t considered an emergency, but if he went home and said “I’m having chest pains” it was covered. Years ago, my sister had surgery. A few months later she got all the expected bills, plus an extra one for a nurse assistant (or something like that). She had no idea what that meant, who it was or why it wasn’t being covered. My dad made a few calls and found that the nurse assistant was the doctor’s personal nurse that generally doesn’t do anything, but they’re in the room ‘just in case’. My sister signed something stating that it was okay for the nurse to be there. She only vaguely remembers signing it. They ended up on the phone with the hospital/insurance trying to explain that A)She signed this form minutes before surgery because they pressured her into it and B)She was at an in-network hospital using an in-network doctor, why is it our fault that the nurse was out-of-network and not covered. Didn’t matter how much they argued about it, they paid an extra grand or so for that nurse to be there. ---
**Author:** ![Typo\_Negative](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/typo_negative/32/484_2.png) [@Typo\_Negative](https://boards.straightdope.com/u/Typo_Negative)\ **Post date:** [June 25, 2019, 8:46pm UTC](https://boards.straightdope.com/t/trump-executive-order-now-requires-transparency-up-front-in-hospital-billing/836033/29 "2019-06-25T20:46:15Z")
> [@Snowboarder\_Bo](#): > > That is the only answer I have ever gotten from a hospital regarding any cost of anything. And it will not cover the other bills you will get months later from doctors who looked a test result, or answered a question from one of your nurses… ---
**Author:** ![Snowboarder\_Bo](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/snowboarder_bo/32/229_2.png) [@Snowboarder\_Bo](https://boards.straightdope.com/u/Snowboarder_Bo)\ **Post date:** [June 25, 2019, 9:06pm UTC](https://boards.straightdope.com/t/trump-executive-order-now-requires-transparency-up-front-in-hospital-billing/836033/30 "2019-06-25T21:06:01Z")
> [@Typo\_Negative](#): > > And it will not cover the other bills you will get months later from doctors who looked a test result, or answered a question from one of your nurses… Aye; I’ve seen those too. ---
**Author:** ![Chessic\_Sense](https://avatars.discourse-cdn.com/v4/letter/c/7c8e57/32.png) [@Chessic\_Sense](https://boards.straightdope.com/u/Chessic_Sense)\ **Post date:** [June 26, 2019, 12:43am UTC](https://boards.straightdope.com/t/trump-executive-order-now-requires-transparency-up-front-in-hospital-billing/836033/31 "2019-06-26T00:43:53Z")
> [@Joey\_P](#): > > Didn’t matter how much they argued about it, they paid an extra grand or so for that nurse to be there. This is why you refuse to pay it, let it go to collections, then tell the collectors to go F themselves. ---
**Author:** ![kayaker](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kayaker/32/441_2.png) [@kayaker](https://boards.straightdope.com/u/kayaker)\ **Post date:** [June 26, 2019, 11:08am UTC](https://boards.straightdope.com/t/trump-executive-order-now-requires-transparency-up-front-in-hospital-billing/836033/32 "2019-06-26T11:08:56Z")
> [@doreen](#): > > I feel like I’m misunderstanding something here - or was a matter of the ambulance out front not accepting your insurance and it was just a coincidence that the covered ambulance was based in your hometown ? My insurance covered ambulance transportation done by the company near my home for some reason (The conversation took place from my hospital bed). It didn’t seem to make sense at the time; having an ambulance drive an hour or so seemed crazy, but it worked. It took a call to my insurance company and maybe twenty minutes on the phone to figure it out. > [@Broomstick](#): > > The works until you’re unconscious and in an emergency situation - then they just do stuff and you get the bill later. So while this might be a boon for _elective_ procedures it will do frack all for emergencies. Heh, you got me. Most of my hospital interactions have been for emergencies, but I’ve always presented conscious. I would hope my gf acts in my best financial interests, but oh well. > [@Typo\_Negative](#): > > And it will not cover the other bills you will get months later from doctors who looked a test result, or answered a question from one of your nurses… Unauthorized charges should be disputed. If your restaurant check has charges for food you did not order would you pay? If your mechanic you hired to change your car’s oil decides to rotate your tires as well, do you just pay the bill unquestioned? ---
**Author:** ![Joey\_P](https://avatars.discourse-cdn.com/v4/letter/j/919ad9/32.png) [@Joey\_P](https://boards.straightdope.com/u/Joey_P)\ **Post date:** [June 26, 2019, 2:51pm UTC](https://boards.straightdope.com/t/trump-executive-order-now-requires-transparency-up-front-in-hospital-billing/836033/33 "2019-06-26T14:51:30Z")
> [@Chessic\_Sense](#): > > This is why you refuse to pay it, let it go to collections, then tell the collectors to go F themselves. Then it fucks your credit and the doctor (or hospital or medical group) may well refuse to see you anymore. If it was my case, I would have escalated it to the Commissioner Of Insurance for my state. I may have also involved the Hospital Association, the Attorney General and someone on the board for the group where the surgery took place and the group that the nurse worked for. It’s pretty underhanded when the doctor sneaks a nurse into the surgical room and doesn’t mention that they may not be covered by your insurance because they’re part of a different healthcare group. ---
**Author:** ![iamthewalrus\_3](https://avatars.discourse-cdn.com/v4/letter/i/258eb7/32.png) [@iamthewalrus\_3](https://boards.straightdope.com/u/iamthewalrus_3)\ **Post date:** [June 26, 2019, 4:53pm UTC](https://boards.straightdope.com/t/trump-executive-order-now-requires-transparency-up-front-in-hospital-billing/836033/34 "2019-06-26T16:53:49Z")
> [@scr4](#): > > Wouldn’t this mean the hospital can’t do _anything_ until the insurance company decides whether to pay for it or not? Presumably the hope is that the hospital and insurance company will figure out how to sort out their shit so that there aren’t surprises later. “How much do we charge for procedure X for patient Y covered by policy Z” is something that could be looked up in a database pretty quickly. The problem is that no one has responsibility for that database being correct, and when an error is discovered, the response is to just bill patient Y and let them sort it out. This isn’t impossible to do. It’s so not-impossible that every other industry in the world manages to mostly figure it out. You never get a bill from the grocery store a month later saying “oh, sorry, the bottle of milk you bought was processed by an out-of-network pasteurizer, you have to pay more”. You never get a bill from your mechanic three months later saying “you paid for a 5W30 oil change, but you actually got 10W20, so there’s an additional charge”. And if you got either of those, you’d rightly tell them to fuck off. ---
**Author:** ![doreen](https://avatars.discourse-cdn.com/v4/letter/d/858c86/32.png) [@doreen](https://boards.straightdope.com/u/doreen)\ **Post date:** [June 26, 2019, 5:17pm UTC](https://boards.straightdope.com/t/trump-executive-order-now-requires-transparency-up-front-in-hospital-billing/836033/35 "2019-06-26T17:17:24Z")
> [@iamthewalrus\_3](#): > > This isn’t impossible to do. It’s so not-impossible that every other industry in the world manages to mostly figure it out. You never get a bill from the grocery store a month later saying “oh, sorry, the bottle of milk you bought was processed by an out-of-network pasteurizer, you have to pay more”. You never get a bill from your mechanic three months later saying “you paid for a 5W30 oil change, but you actually got 10W20, so there’s an additional charge”. And if you got either of those, you’d rightly tell them to fuck off. It’s not impossible to do because every other business runs on a different model completely. I don’t go to my mechanic, not ask about the price and just assume that my extended warranty will cover the work _and_ that my mechanic will accept whatever that company is willing to pay. Sure , the whole system could be changed- but then it would look more like my dental insurance always has ( because for some reason, dentists are less likely to participate in insurance plans than physicians) Dentist - you need X, Y Z. it will be $2500. Dentist sends a preauthorization form to my insurance company. I either wait to get the work done until my insurance company says how much they will pay ( if I’m lucky $1200) - or I start the work, knowing that I might have to pay the entire $2500. I never get a bill from my dentist 3 months later- because I got the price at the beginning. ---
**Author:** ![Musicat](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/musicat/32/20189_2.png) [@Musicat](https://boards.straightdope.com/u/Musicat)\ **Post date:** [June 26, 2019, 5:37pm UTC](https://boards.straightdope.com/t/trump-executive-order-now-requires-transparency-up-front-in-hospital-billing/836033/36 "2019-06-26T17:37:42Z")
> [@Joey\_P](#): > > …My sister signed something…She only vaguely remembers signing it. They ended up on the phone with the hospital/insurance trying to explain that A)She signed this form minutes before surgery because they pressured her into it and B)She was at an in-network hospital using an in-network doctor, why is it our fault that the nurse was out-of-network and not covered. > Didn’t matter how much they argued about it, they paid an extra grand or so for that nurse to be there. I had something like this happen. As I was being wheeled on a gurney to the operating room, already partially sedated, a nurse rushed up to me with a clipboard and wanted my sig on some tiny-print, multipage consent form. Supposedly (?!) she had forgotten to present it to me earlier. Although I was in no condition to think straight, I asked her (on the run) what would happen if I didn’t sign it. She said they would cancel the operation and send me home, possibly at my expense. I signed. If Trump et al really wanted to help poor people – which I doubt – maybe he could tackle [this problem.](https://www.npr.org/sections/health-shots/2019/06/25/735385283/hospitals-earn-little-from-suing-for-unpaid-bills-for-patients-it-can-be-ruinous) ---
**Author:** ![iamthewalrus\_3](https://avatars.discourse-cdn.com/v4/letter/i/258eb7/32.png) [@iamthewalrus\_3](https://boards.straightdope.com/u/iamthewalrus_3)\ **Post date:** [June 26, 2019, 9:27pm UTC](https://boards.straightdope.com/t/trump-executive-order-now-requires-transparency-up-front-in-hospital-billing/836033/37 "2019-06-26T21:27:27Z")
> [@doreen](#): > > It’s not impossible to do because every other business runs on a different model completely. I don’t go to my mechanic, not ask about the price and just assume that my extended warranty will cover the work _and_ that my mechanic will accept whatever that company is willing to pay. Right, if you don’t ask questions about prices and ask to be billed later, then you will get bills later and not know how much they will be for in any industry. The difference is that as far as my experience goes, there is no way to get the information I want. If I ask the medical provider how much things cost, they’ll tell me to ask my insurance company. If I call up my insurance company prior to a procedure, they’ll give me a guess and tell me to read the policy. If it turns out that somehow the guy who carried the vials of blood to the lab (who I don’t get to choose or know about) didn’t specifically contract with my insurance company, then everyone gets to make up numbers and argue about it. At no point can you convince anyone to give you legally binding piece of paper with a number on it and say that this is how much it’s going to cost and have it actually be valid, the way it is in every other industry. It is not possible to be an informed consumer with medicine. ---
**Author:** ![doreen](https://avatars.discourse-cdn.com/v4/letter/d/858c86/32.png) [@doreen](https://boards.straightdope.com/u/doreen)\ **Post date:** [June 26, 2019, 11:19pm UTC](https://boards.straightdope.com/t/trump-executive-order-now-requires-transparency-up-front-in-hospital-billing/836033/38 "2019-06-26T23:19:28Z")
> [@iamthewalrus\_3](#): > > Right, if you don’t ask questions about prices and ask to be billed later, then you will get bills later and not know how much they will be for in any industry. > > The difference is that as far as my experience goes, there is no way to get the information I want. If I ask the medical provider how much things cost, they’ll tell me to ask my insurance company. If I call up my insurance company prior to a procedure, they’ll give me a guess and tell me to read the policy. If it turns out that somehow the guy who carried the vials of blood to the lab (who I don’t get to choose or know about) didn’t specifically contract with my insurance company, then everyone gets to make up numbers and argue about it. At no point can you convince anyone to give you legally binding piece of paper with a number on it and say that this is how much it’s going to cost and have it actually be valid, the way it is in every other industry. It is not possible to be an informed consumer with medicine. Well, sometimes you can - I know exactly how much my primary doctor will charge for a visit, because he doesn’t accept my insurance. I could have called the lab to find out how much the blood work would cost if I was self-pay. The problem with the lab was that they did accept my insurance - and when the nitwit at the doctor’s office put it through as “self-pay” it took two months of wrangling to get them to change it so that I paid my $20 copay instead of the $200 they charge for self-pay. The issue is not exactly that the doctor can’t tell you what he’s charging and the insurance company can’t tell you what they will pay - it’s that the doctor charges a different amount depending on whether you are insured or not and the insurance company doesn’t know how much they will pay until they know what the bill is- I had a ultrasound for which the “charge” was $600. That doctor participated in my insurance, which paid him $211. If he only charged $200, they would have paid less so the insurance company can’t tell me how much they will pay without knowing what he charges. It’s like having a roadside assistance plan that reimburses “up to” a certain amount- neither the guy towing you nor the plan can say how much you will pay in the end because he doesn’t know what your plan will pay, and they know they pay up to $50 , but don’t know if your tow is going to cost $30 or $100. Most of that only applies to out-of-network doctors - you’ll almost always know how much you will end up paying a participating provider. The problems tend to come in when you go to a participating doctor/hospital and some doctor/lab there doesn’t participate. But states can regulate that and some [do](https://www.commonwealthfund.org/blog/2019/state-efforts-protect-consumers-balance-billing) - I don’t actually know if the Federal government can regulate that. I mean, we could change the whole system to be like my dental insurance has always worked ( and how old-fashioned medical insurance worked) - but I don’t think people will like it any better. ---
**Author:** ![thorny\_locust](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/thorny_locust/32/431_2.png) [@thorny\_locust](https://boards.straightdope.com/u/thorny_locust)\ **Post date:** [June 27, 2019, 4:03pm UTC](https://boards.straightdope.com/t/trump-executive-order-now-requires-transparency-up-front-in-hospital-billing/836033/39 "2019-06-27T16:03:30Z")
In addition to what others have pointed out about the impossibility of getting a clear statement in advance for medical work as opposed to one for mechanical work: – If I’m significantly sick or sedated, I’m not going to be taking my car in for repairs, nor am I going to be expected while in that condition to sign anything. – If something goes wrong or the mechanic finds another serious problem while doing the work I agreed to, said mechanic can stop in the middle and get ahold of me (taking whatever time is needed to do so, presuming they’ve got room to park the car someplace which is very likely) and I can consider the options (taking whatever time I need to do so) and then decide whether to have the extra work done. If I decide not to have it done, or not to have it done by that particular shop, I can take the car somewhere else (having it towed if necessary), or sell it and buy another car. There are many medical procedures to which none of this applies. ---
**Author:** ![kayaker](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kayaker/32/441_2.png) [@kayaker](https://boards.straightdope.com/u/kayaker)\ **Post date:** [June 27, 2019, 4:19pm UTC](https://boards.straightdope.com/t/trump-executive-order-now-requires-transparency-up-front-in-hospital-billing/836033/40 "2019-06-27T16:19:40Z")
> [@thorny\_locust](#): > > – If something goes wrong or the mechanic finds another serious problem while doing the work I agreed to, said mechanic can stop in the middle and get ahold of me (taking whatever time is needed to do so, presuming they’ve got room to park the car someplace which is very likely) and I can consider the options (taking whatever time I need to do so) and then decide whether to have the extra work done. If I decide not to have it done, or not to have it done by that particular shop, I can take the car somewhere else (having it towed if necessary), or sell it and buy another car. There are many medical procedures to which none of this applies. Personally, so long as I’m conscious, I retain the option of declining further care in a medical situation and I’ve acted accordingly. When I had heart problems that led to stent placement, I was told that if a stent was found to be insufficient, I would go directly to the OR for bypass surgery. I explained to my cardiologist that I would not consent to bypass, and my original surgical release was torn up and reprinted to reflect my desires. Had my cardiologist refused to proceed as I wished, I’d have left his care and found another cardiologist. [Previous page](https://boards.straightdope.com/t/trump-executive-order-now-requires-transparency-up-front-in-hospital-billing/836033.md?page=1) [Next page](https://boards.straightdope.com/t/trump-executive-order-now-requires-transparency-up-front-in-hospital-billing/836033.md?page=3)