SF hospital charged $15K ‘trauma response fee’ for baby that needed no treatment
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I don't care who, Bernie, Trump, some socialist, take this cause (hospital billing) and have them come correct. They need someone to get tough and straighten them out.
I mean, it's legalized robbery. Nothing less.
We should demand price transparency -- as we do for almost all direct-to-consumer purchases. Businesses can charge different amounts for volume purchases to other businesses, but it would be considered discriminatory if a restaurant didn't show their prices and then when you got your bill, it said -- oh, your company's not paying for it -- so it's $15,000 in extra fees.
I know a company that was trying to help patients understand their medical bills, and for one bill, the hospital accidentally put down 10cc for an antidote for a snake bite, 10 times, when it should have been just once. The cost was in the tens of thousands instead of the thousands, and the hospital eventually fixed the claim and resubmitted, but the insurance company simply billed the patient.
The only way this changes in our fucked up system is if one big supporter, say tech companies, have a reason to collectively force the politicians that support them to start an assault on the big health/pharma industries. But no company wants that. All industries benefit from the fucked up health insurance system because it means all American must have jobs. It's not an option because no one can afford to get sick or break and arm without one (with health insurance).
I'd suggest reading The Dictator's Handbook. It goes into this pretty extensively.
Trump/Hillary hate/loyalty we see in this country is really sad and misguided. It's attacking the runny nose and not the bacteria that's causing the infection. The people who run this country are not the Congress and Senators and President, but all the people who pay their wages: Microsoft, BASF, Boeing, Facebook, Timewarner, Exxon, Google, etc.
My opinion based on limited information within the article is that the field EMS suspected a closed head injury. The trauma "doctors at the hospital quickly determined that baby Jeong Whan was fine". If the baby had an MRI instead of a medical exam by a team of specialists, the headline would lose some weight.
The fee is to staff ED specialists 24/7. I believe the better question is: "should we charge for resources that were used but stood down after initial assessment by the trauma team?" From the perspective of the EMS field, there are protocols that describe tbe patient condition, mechanism of injury and other indicators which dictate a trauma activation.
How so? In my country (Italy) for an MRI I would pay from 42 USD to 81 USD, depending on my income.
Not saying that's its real cost since we pay taxes to grant this to everyone, but from here to 18k...
And that's the most charitable evaluation. They "quickly determined that the baby was fine." So what did the hospital do, charge out the entire cost of running the ER to one unlucky family since they were the only case who was brought in that hour?
Improved price transparency might help, and would be a relatively easy thing to improve, but with most patients not being responsible for paying their own costs, I'm not very optimistic about that route.
If one could incentivize every patient to upload their bills to an open source service that would crunch the data and spit it out anonymously online showcasing hospitals & services rendered + insurers et al.. then I think we might be on our way to true price transparency and a potential disruption in US healthcare.
* ah, no co-pay by the way, I have no idea how expensive those things are.
I wonder if there’s a collection of this sort of article somewhere, all these journalistic accounts of ordinary people’s financially nightmarish encounters with the American market for healthcare. It feels like I’ve read dozens of them, and they’re all basically similar, not just in the facts they relate of each debacle, but also in their lack of insight into what’s really so fundamentally broken about our healthcare markets.
0. https://johnhcochrane.blogspot.com/2018/06/cross-subsidies.h...
It wouldn't be that hard to just take a bunch of tax money, and provide a bunch of health care. Or alternatively, provide a bunch of health insurance. But since the US isn't willing to do that, but does want the services, we get this.
There's no free lunch, and the harder you try and find one, the more warped (and, ultimately, expensive) it's going to end up being.
Elaborate, please, if it is so easy.
I'm not even sure the txation in france is higher than in the US.
Then you spend this money on health care (ideally), or (failing that) health insurance (the point of insurance is the spread risk, but the government is already a big enough risk pool, so anything other than self-insuring is a blatant waste of money), with a strong focus on just letting the market work. Do you wish that everyone had access to treatment A? Then just pay people to provide it. It's amazing how well that works!
(One of the ironies of this debate is that the US tends to be shockingly socialist in how it provisions care. Land of the free, home of the brave, right up until it involves medicine, and then it's the last redoubt of five year plans, price setting, and socialist planning, which works just as well as it did under Khrushchev. Northern European countries have eye watering taxes, but the saving grace is that they spend the money efficiently.)
This is the sort of thing that basically all other first world countries have done, and it works pretty well. It's not cheap (anywhere), and it would be especially not cheap in the US due to their very, very long history of making poor choices that drive up the cost of health care, but it's a viable option.
(Example: Most first world countries build hospitals in order to provide a lot of high quality care efficiently. This means things like large open wards, because that allows a smaller number of nurses to monitor a larger number of patients, and nurses are expensive, and it's not like having a private room is going to make your broken leg heal faster. In the US, hospitals are build without open wards, because patents prefer private rooms, and who cares if that makes things horrifically expensive, because the guiding principle of US health care is "I don't care what it costs, I'm not the one picking up the tab!". Unfortunately, those hospitals have been built, and they're not readily retrofitable to more sensible designs, and we'll be paying off the bonds used to finance them for decades. Which means everything in the US will be needlessly expensive regardless of how you pay for it, but it's too late to fix it now.)
Of course, politically, none of this is going to happen; instead Congress will just keep passing laws to mandate More Good Stuff and Less Bad Stuff, and then feeling very aggrieved when it doesn't work out. The history of US health care since WWII has basically been one long string of poorly thought out reforms that have driven prices up. Why stop now? But just because the US won't do it doesn't mean it wouldn't be easy if they wanted to.
My friend was discharged in a couple of days... with a bill of 70K USD. Except for an IV and a Ryles tube, there was hardly any other intervention.
Having just finished college, my friend did not have an insurance plan that could cover such a huge bill. Thankfully the state stepped in to help since the yearly income was below the federal poverty line. Otherwise, I can't imagine the plight.
For once, my friend was thankful for being a broke college grad.
a) they make up prices as they go
b) they like to charge for things that never happened or put a several thousand percent markup on things
They said that Obamacare was broken beyond repair. The same should be said for the current system and its billing practices.
I remember 2008
It is true. The Democrats had a filibuster-proof 60-member caucus[0] in the Senate, full control of the House, and the Presidency. They didn't need (and didn't get) a single Republican vote. But as they delayed while busy loading the bill with even more disastrous spending (e.g. community pools, Risk Corridors, etc.), their Senate supermajority fell to 59.
[0] https://www.senate.gov/legislative/LIS/roll_call_lists/roll_...
In the case above, there was zero bipartisan cooperation past the original proposal, so the individual senators really mattered.
Want to know the daily rental rate for half of a shared room at Stanford's hospital? $17,000. That's not including any of the services, that's just for half of a tiny room. If there was a Four Seasons next to the hospital, it would be a small fraction of the price. That can subsidize a LOT of unpaid medical care. When you tack on the other care for a few days, it comes out to about $100k for a few days and maybe 24 hours of caretaker time during that time.
I think the real reasons are much closer to the reason college tuitions are through the roof - a) there are far more "professional hospital administrators" now, drawing large salaries without a direct impact on quality of care, and b) relative price insensitivity by clientele, because they're either not paying for it themselves, or they're desperate for good medical care and are willing to pay any price at the time, and c) egregiously fancy expansions with fine woods everywhere in the lobby, marble, etc.
How come they don't get a bill after treatment?
Same here in India. For all the talk about Medical Tourism to India, it works only because Americans come here to India with Dollars, and $1 = 70 rupees. Your purchasing power suddenly increases by 70 times.
For Indians in India. Its the same near US level rip off. Sometimes its also hard to not sympathize with the doctors. It takes the best years of your 20's and early 30's to get to be a good doctor, and its expensive to get all those degrees and training. So they charge whatever they have to, to not only recover all that money but also make a fortune worth profit along the way.
A lot of time this is done through unethical means. Ordering tests the patient doesn't need(commissions with the labs), prolonging treatments to optimize for per visit costs, writing medication the patient doesn't need(again commissions with the pharmacy) etc etc.
But yeah, I agree with you. Even In India, Most doctors I talk to want(ed) to go the US to settle there. Largely because of the apparently insanely high pay and perks. One person I talked in my extended family almost talked about it like it wasn't something they had to even think about. If you are a doctor you had to settle in the US. The profession is just too profitable in the USA, to not move to there.
Don't want to be a snob, but $1 = 70 does not mean that the purchasing power of the dollar is 70 times. Purchasing power is related to the services and goods you can get.
Eg: For $1, you can get a single nissan noodle bar in the US. For Rs70, you get around 7 maggi noodle bar's in India. In this case the purchasing power of the rupee is 8 times that of the USD.
> Same here in India. For all the talk about Medical Tourism to India, it works only because Americans come here to India with Dollars, and $1 = 70 rupees. Your purchasing power suddenly increases by 70 times.
How is this logic?
In fact you will be a tad little surprised to know that people here fight for US work opportunities(a.k.a known as 'onsite opportunities'), work for a few years in the US, come back and buy homes. Many people even own multiple homes this way.
It was all the rage a few years back, crazy workplace politics for this though.
For something small, like Fever or Stomach Upset may be.
For bigger problems its not easy, and most of the time they just give up(Embrace death). In Bangalore, there is a hospital called Bowring and Lady Curzon Hospital, its sort of like a government hospital. For decades its well known that when burn patients arrive, and if the victim is really poor, they silently recommend euthanasia. And most people opt for it. Its just the cost of treatment is too expensive, and the whole family goes down in the financial burden that follows.
Also please take a look at government hospitals like NIMHANS in Bangalore, its like the most depressing place you will visit in your life. You have to pay bribes for simple things like IV drip. And most people are very ill and sleep on the footpaths and hospital compound. Most of the times let alone having money for treatment they don't even have money to go back home to their small towns and villages.
Personally I had experience with one relative who got Guillane barre syndrome, their family comes from Kolar(A place 70 kms from Bangalore). He was a flower seller. He refused our help out of self esteem, but we had to bribe through ward boys, nurses and doctor secretly without him knowing to speed up things and get him everything from a bed to the right treatment.
We spent 4 weeks in the hospital. 1 week until it was diagnosed in the MRT, 3 weeks with 3 different antibiotic treatment and another two month antibiotics at home.
All this while my wife continued to study for her PHD so I stayed away from work and lived with my son in the hospital.
This whole experience did cost us around 200€ (incl. gasoline to drive to the hospital) while still getting full income from my employer.
On the other hand his birth was near $200k because he was born early and had a long hospital stay (he's fine now, long term premature outcomes are amazing). Nothing we could have done to prevent it, know it was coming, it would have financially destroyed us at that time had we not had insurance.
The US healthcare system is borked.
Not uncommon for the hospital to be paid 25-33% of the bill. Sometimes a lot less than that.
One of the reasons the list price is so high is due to “usual and customary” laws. An insurance company can’t pay for than that, so hospitals set it extraordinarily high.
Also, contract negotiations are based on chargemaster rate and discount. They keep cranking up the list price and insurance comes back and increases the discount.
There were people there anyway, an attending physician looked at the child, talked to the parents (all doctors want is your anamnesis!) determined that nothing to worry about, maybe keep them in observation, and that's it. There's not even a word about doing an Xray/CT or any kind of imaging to check for internal bleeding.
Probably the "activation" of the Trauma Unit is that when they called 911, the hospital booked them and was ready to receive them.
Put another way, if this family does need the trauma unit for their child next month, will they hesitate? Which is worse for society?
Obviously there’s a balance to be struck (hypochondriacs), but I think we can collectively come up with a situation in which both the individuals get paid and the family isn’t being so financially burdened. False alarm or no.
Other countries have figured this out long ago. If you have to go to the hospital in these countries, finances and costs are a non-issue - the only thing on your mind will be your health and a speedy recovery.
A few months ago my wife was showing me atrocious bills people were posting on FB, I didn't know whether to laugh or cry. It hit home because we "accidentally" got a bill when an in-network lab sent a blood test to an out of network testing facility and we got a $14k bill... for a blood test.
Just recently, a 2 hour ER visit for my toddler cost $3.5k for a breathing treatment, some Tylenol and some influenza tests. All part of my high deductible plan.
I used to be on the side against healthcare reform. I'm now counting the seconds until we have ANY regulation to stop this madness.
Why?
Trauma teams legitimately require such expense. There are surgeons, nurses, neurosurgeons, and others on call 24/7 sleeping on the hospital so they can get to victims of trauma within 5minites. Gunshots, stab wounds, car accidents, massive balconies falling with kids on them, etc, all require legitimate trauma activations. So do drinks and homeless people who get hit by cars or stabbed in the middle of the night, and many who don’t have insurance are still treated by the hospital. Some hospitals bill all patients 7-10 times the actual costs, get paid 1-2 times actual by insurance. Uninsured either don’t pay, or negotiate down, or are plagued by the full bill designed to compensate for the others who don’t pay.
If a hospital isn’t able to cover the costs of a trauma team, that means they lose their trauma designation and any local patients bleeding out because of trauma have to be trekked by ambulance or helicopter to the next trauma center, which in SF is Stanford or John Muir in the East Bay. They might have needed to pay another 25k if a chopper was called for this.
In that case this case can as well be summarized as: hospital seizes opportunity to maximize profits on baby, then every decision in the chain becomes clear.
Second, the article thinks that this was fraud. Figures. It may not be too late for them to call the hospital and point this out and ask them to zero out the balance. This hospital, when it had its prior name, did something similar for a friend of mine, albeit his bill was about $1-2k and it was not fraud. Considering they might be on the wrong side of the law, this seems like a solution both sides can get behind.
What if I had no insurance? Would I get billed that insane number and have to spend hours whittling it down?
My dad was commenting on how the drug he takes regularly in his home country (outside the US) is 1/10th the price of what it costs here.
The health insurance system is broken in USA (who knew?). Everything is artificially over-inflated because it all gets "negotiated" down in the end. This creates a lot of room to maximize your net revenue when you set prices arbitrarily high.
I was admitted to hospital, was charged over $19000 (that is nineteen thousands dollars) per night for bed. Just for bed. And it was a "cheap" option with person crying in agony next to me whole time.
Total bill was 74k$ dollars just for hospital service. Emergency services, E.R., surgery, anesthesiology all Extra.
Welcome to US.
P.S. With that prices, hospital easily would make it in top 20 most expensive hotel rooms of the world, except I didn't have a choice but to pay for it.
These values are utterly unreasonable. Someone, somewhere; is doing something extremely unethical.
The fact this can even happen somewhat indicates there’s a lot of “power” involved.
—
Edit: another poster had mentioned that some costs are included to cover other admissions in which fees are not paid - no matter the reason.
So, whilst this seems quite logical; it bothers me this is not clearly indicated. Its a pretty poor attempt to fix a clear, and genuine, other problem.
This is all pretty crazy - $200/hour for a brain surgeon, sure, but there's no way the nurse is getting that. One of the big missing data points is how many people were called in. 15k is pretty reasonable if a 50 person team was called in - but then, why would a 50 person team be called in?
I guess minimum callout fees, etc - in your proposed scenario including a large callout of resources.
Hmmm!
Thanks for your reply!
It's not like it's going to affect their credit rating in Korea or anything?
On the other hand medical bankruptcy is sadly frequent in the US so international patients isn't really a concern.
https://www.reddit.com/r/legaladvice/comments/1m7p78/foreign...
On the other hand, looks like the UK does hold debts against a would be visitor, according to forums.
Emergency care and primary care are always free for everyone, and will not lead to charges, and so non-payment isn't an issue.
This obviously varies by country. E.g. for travel within the EU, a country will pay for their travelers healthcare. I live in Japan, and while the universal health insurance will pay for treatment sought outside of the country, they will only pay what it would have cost if it was performed in-country. So that doesn't help travelers to the US.
The family can opt to go there and go through with it, or simply never visit the US again.
Also probably due to some MLAT [ https://en.wikipedia.org/wiki/Mutual_legal_assistance_treaty ] eventually they could be even extradited.
But usually it just gets negotiated down to something sane.
Also, I wonder how feasible it would be for foreign governments to pay for the emergency care of their citizens when they have issues in America, and fund it by charging visiting American's American-style medical bills for any medical care they receive while there.
The two I see are mostly
1. "I don't want to pay for other people's healthcare. Other people make poor health [dietary, etc] and financial [they're poor] decisions and they should pay for it themselves." A lot of young people do not want to pay it forward for the healthcare they will need when they get old ("I haven't been to a hospital in years! I'm healthy!").
2. Distrust in the government in running a fair and efficient system ("death panels" etc)
I have two kids, and have used the emergency care unit a couple of times throughout my life. Total cost $0 in care fees. (They are allowed to charge for stuff like bandages and such for non layovers, usually $5-$20 each visit).
We don't have health insurance, but some insurance companies have begun selling "treatment guarantee" which guarantees start of treatment typically within 14 days of injury. (For non life threatening ailments of course. Elbow pains, leg pains, such..) The best thing about those are that they are usually paid for by your employer because they want you back at work as soon as possible :D (The premium is added to our income tax though)
Socialism hell yeah!
> in January 2008, Hannaford Bros., a supermarket chain based in Maine, began paying the entire medical bill for employees to travel to Singapore for hip and knee replacements, including travel for the patient and companion ...
> In 2000, Blue Shield of California began the United States' first cross-border health plan. Patients in California could travel to one of the three certified hospitals in Mexico for treatment under California Blue Shield.
If there is one area that begs to be fixed, disrupted and overhauled it is US health and scammy insurance industry.
This has to be satire.
...right?