Went to ER for the first time ~3 months ago. I was charged about $4000 for:
- Cleaning a wound (with water/desinfectant).
- Some antibiotics.
- A band-aid and gauze.
I get how, with labor cost and all, that might cost $200. Maybe $300? I have no idea how this can cost $4000.
Hospital billed $6000 (already negotiated down with insurance). Insurance paid around $4000. They wanted me to pony up 2k. Told no. Went to collections, negotiated to just under 1000. According to the line items, doctor took ~$100.
I have no clue why this was so high. My wife did pelvic ultras-sounds at another hospital (so not exactly the same procedure), but was billed $300.
The only reason I can think of is the 'name' of the hospital. It's in the Bay Area and shares the name of a well known university.
Had I known, I would never have gone there. That incident caused me to ditch my plan and go with Kaiser. It's been ok so far. No ultra-sounds, but I got a sleep apnea exam and a cpap for about 150 - and that was disclosed upfront.
Yet, I've heard on HN so many people love that place. I can't fathom how that is the case. Even military clinics are decades ahead of Kaiser.
The only positive thing I have seen about Kaiser is that they are an amazing drug company. Each campus has 2 to 4 pharmacies. That must be a very lucrative business.
Normally I'd say that's far fetched but after having relatives advised to get unnecessary surgery I wouldn't be surprised.
First pregnancy we had a scare about genetic issues. Instead of wondering where the money would come from, I was able to take time off work and be there for my wife between the phone call and the battery of tests done 45 mins away. Another hour long ultrasound and a sit down with a geneticist in the afternoon. No bills, invoices, anything.
There's simply no reason for capitalism in healthcare to directly involved the patient. At least I believe that to be true.
There's simply no room for capitalism in healthcare
https://www.opensecrets.org/lobby/top.php?indexType=s
Heck, if you want to know why something in the US sucks, just look at that list.
Massive government corruption from legal bribery.
In all seriousness, that they are able to charge that much with no upfront warning is pretty insulting. But then again they know they have you hostage, its not like you are going to change your mind and tell the doctor to just leave it in there.
I hear people make this argument about patients who are bleeding out, and that's one thing. You're not going to suffer any extra harm from leaving a bean in your nose for a week. The nose just dumps out into the back of your throat. Why wouldn't you shop around in that case?
- (1) With an admirable humanitarian intention, the government forces hospitals to treat patients whose life is immediately in danger, and figure out later whether they'll be able to pay. If 1/10 people have the means to pay for the treatment they receive, then you're paying for your treatment, plus the expensive life-saving treatment of nine other destitute people who couldn't pay.
- (2) It's a monopoly. If your choice is letting your daughter possibly lose a finger, or taking her to the hospital, you'll take her to the hospital. Because you don't really have a satisfactory alternative.
- (3) It's opaque. You have no idea what treatment she'll need or how much it'll cost going in. They're loth to make promises about this up-front ahead of a diagnosis.
- (4) Because they can. Why would they ever charge $400 when they could charge $4000? The only surprise here is that it's not $40,000 or $400,000 or $40,000,000.
And almost all hospitals are walk-in without appointments, and many big ones have night coverage.
ER? sure, it's there. But only if you have rebar sticking out of your torso.
And, frankly, part of it is because hospitals can’t refuse care to anyone and if they can’t pay, someone else has to.
As far as I can tell the problem is really the big HMOs seem to be essentially managing another companies money, rather than their own, and they essentially get a cut of money going in and out of them.
There's benefit for everybody, which is risk reduction. You actually blame poor people for going to the ER in case of emergency.
I think that's a cheap excuse they have to rip off everybody else. I would like to see the actual numbers of people who aren't paying and what losses they incur.
https://www.aha.org/data-insights/2018-01-03-uncompensated-h...
Somewhere in the ballpark of $40 billion dollars a year vs total revenues in the ballpark of $3 trillion. Various aspects of Obamacare had the effect of leveling them off.
There is likely additional underpayment due to Medicaid and Medicare (to the extent those programs are underfunded and operate by mandating care, they are a hidden tax).
[0] https://www.nytimes.com/2014/09/21/us/drive-by-doctoring-sur...
Even worse is receiving bills from various providers up to a year later. How are these people still in business?
The American system is literally (literally literally) unsustainable.
It's a lose lose situation.
Some urgent care clinics post wait time online so you can find out how to see a doctor the fastest way.
These are often misleading, though - the clinics that market this way essentially perform triage with docs instead of nurses, so you're technically seen by a doc quickly. Time-to-discharge would be a far more useful data point.
They're also often marketing like this because they're standalone clinics that are out-of-network for major insurers in the area. https://khn.org/news/surprise-that-urgent-care-center-may-se...