I got burned by this in California a decade ago. A dentist charged me $4,500 to fix a broken tooth (panic!) and fill in a cavity on a Sunday.
Had I known then what it might have cost I'd have simply flown back to Europe in the next flight ($600-800 at the time) and get the same thing done for under $100-200 with a full refund from my local social security.
Adding insult to injury I had a very expensive international health insurance policy owing to my traveling around the world back then. And they didn't cover dental with my plan. I knew they wouldn't. But it was still mind boggling to me in that I never expected a casual procedure that would have cost me €150 at most anywhere in Europe - most of which would have gotten refunded at that - to cost me a whopping $4,500 in the US.
You only find out just how badly it works when you need it the most.
Do dentists in Europe work on Sunday? In my experience the grocery stores aren't even open...
Emergency dental care is provided in the US as well. Filling a cavity is not considered an emergency.
Actually it wasn't - went from nothing to blinding pain as if someone threw a switch. I'd have 10-15 minutes of agony then it turned off for the same time and it repeated at that frequency all of the Saturday until a GP came out on the Saturday evening and gave me painkillers and told me to go to the emergency dental clinic the next day.
It was right in the middle of my 3 years exams at University - which was a bit of bad timing!
The US isn't a monolith. The majority of the population very much wants meaningful health coverage, but thanks to Supreme Court decisions like Citizens United, corporations are entitled to free political expression under the first Amendment, so they can give unlimited amounts of money to political candidates. This allows uberwealthy individuals to form corporations for the explicit purpose of installing anti-taxation cronies into legislatures at both the state and national level.
Our political process is very corrupt, and it's taken a national emergency (Trump's Presidency) to wake people up. The 2018 midterms demonstrated that far more citizens are paying attention and plan on voting, so hopefully the US goes single payer soon, but it's going to be a brutal political fight.
Bernie who was the most vocal about changes was taken out by Hillary, but no one batted an eye. No one really wants change to the healthcare and pharma industry as it will hurt the entire ecosystem (especially advertising $).
This second aspect has never been addressed on a national level, or barely at all.
At the state level, if you think of them as their own countries some do have very accessible programs. Some even having universal healthcare in that state.
So the US is complicated.
And then there is the distrust of how people of other cultures in our country would use a subsidy if it isnt clear that they have the same ethics and motives. This exacerbates many political issues.
Because disinformation campaigns have pushed people to vote against their interests.
They can't. That's the problem - there's little you can do to stop it from happening, even if you're aware of this sort of billing problem and try to take steps to prevent it.
https://www.npr.org/sections/health-shots/2018/08/27/6408918...
> Surprise bills occur when a patient goes to a hospital in his insurance network but receives treatment from a doctor who does not participate in the network, resulting in a direct bill to the patient. They can also occur in cases like Calver's, where insurers will pay for needed emergency care at the closest hospital — even if it is out of network — but the hospital and the insurer may not agree on a reasonable price. The hospital then demands that patients pay the difference, in a practice called balance billing.
https://www.npr.org/sections/health-shots/2015/02/17/3869088...
> The surgeon's office later told her that he belonged to two different medical groups. One was in Morgan's husband's health plan network, the other wasn't.
I got this one, it was mindblowing. For ER work, they'd bill through one practice, for scheduled appointments, another.
I got balance billed for $11k. My father, who worked in employee benefits for over 30 years, couldn't even figure out what was up at first. Then they filed to send me to collections because I kept refusing to pay (note, I'm in California and this billing is illegal for life-threatening emergency visits matching the situation I was in). Finally, the insurance company stepped in and covered me, but we were only able to achieve this because my family knew people personally at the insurer.
All kinds of messed up.
So they jack up everyone else's bills in the hopes that enough people will pay that they'll make a profit.
Insurance companies will usually push back, so (sometimes partially) uninsured people with decent credit hit with huge charges.
No. That’s the justification given so that people get angry at the wrong thing.
Hospitals charge this because they CAN. They are doing what businesses do and that is maximizing their profit.
Don’t get angry at the uninsured get angry at the politicians for enabling a broken system.
Including all the non-profit hospitals? What's their motivation?
"Non-profit" doesn't mean "can't make a profit".
Rarely paid for with reimbursement revenues.
> giant endowments
Definitely not paid for with reimbursement revenues.
> amenities for staff
Try cutting these, and see how quickly 1199 SEIU comes down on you.
> raising administrator salaries "to retain premium talent", etc.
Even if you assumed that there were no relationship between the wages paid and the quality of work performed (there is), these are nowhere near big enough to account for the difference. They're also not that far out of line with other countries, either: 25% in the US, compared to 20% in the Netherlands, for example.
But more so than that: they're SG&A expenses, which are further down the balance sheet than the reimbursement revenues. And yet, hospitals actually lose money on the top line for Medicare patients (who represent about 40% of the market). That's the real reason reimbursement rates are raised for private insurers - the private insurers are required (by law) to pay more, and they need to subsidize the sub-COGS reimbursements from the public insurers (Medicare, and to a lesser extent Medicaid).
So no, none of the things you listed actually explain the reason hospitals charge private insurers the rates they do.
Non-profit simply means any surplus of revenue is spent. So, the more revenue generated by a non-profit's paying customers means they get to funnel that to their core mission (likely research, possibly those that can't pay, or cynically more salary for those running the show).
Hospitals make very low profit margins; hospitals have been hemorrhaging money and either being bought out by hospital systems or insurers, or even shutting their doors entirely.
In any case, it's not uninsured patients that cost the hospital money; there aren't enough of them to make a difference at most hospitals. The patients that cost hospitals money are Medicare patients, because Medicare reimburses rates that are below COGS, and private insurers are required by law to reimburse more.
In other words, yes, it's the politicians that enable a broken system, but no, it's not the uninsured patients who are at fault, and it's not "profit-maximizing businesses" that are at fault either. Hospitals don't want this convoluted billing system any more than patients do, but it's literally forced on them as a result of accepting Medicare patients.
Given that this is going on, why not just switch to a single payer system and spread this out over a much larger population rather than each hospital trying to insure against it?
You can't get months worth of chemo or physical therapy or dermatological consults or whatnot at an ER.
What percentage of hospital budgets is lost to this?
If it's anything less then 95%, I don't see how the assistance of an out-of-network nurse could possibly cost $5,000.
How many patiens are uninsured? 10%? 20%?
This still does not explain how the hospital can bill $5k for one hour of a nurse that may be making herself $50 per hour at most.
This is actually only a half truth. Emergency rooms are required to treat patients who need emergency care. They don't need to fix all ailments. If you have cancer they can turn you away, but if your organs are failing as the result of cancer they have to treat you. If you need a heart surgery they can turn you away, but if you're having a heart attack they need to treat you. For the most part, treatment is pretty much just making sure you're stable and can leave the hospital without immediately dying. This only applies to emergency rooms as well. Where you go to get surgeries is usually not the same place you go to treat an emergency condition. It might be affiliated with the same hospital, and might be attached to the emergency room, but it isn't itself an emergency room.
Source: https://www.nyacep.org/practice-resources-2/resources/practi...
Hospitals are for-profit entities that will optimize debt-collection and bargaining power over patients. They will start taking payment upfront as well as influencing patients to choose financing options that are in the best interest of the hospital and not the patient themselves.
It's hard not to feel like the whole system is rotten.
Call the hospital and demand it be removed from your bill. That's what others[1] (including myself) have done and the fraudulent charge was eventually removed.
The absurd part is that you would even need to do this. How many people don't understand you can fight healthcare charges and get them removed? How many have the free time that it takes to call the billing department over and over?
The whole health insurance system is trash and needs to be replaced.
The surgeon's assistant was the out of network provider and he was also part of a different practice, so it was his practice billing department that would not budge because they deemed their costs as reasonable and "already discounted".
Otherwise underpaid, overworked surgical residents leave either due to truly catastrophic burnout, mental illness, family emergency or pregnancy.
They are replaced by moonlighters, because the economics of the surgery are that the nurses and other unionized employees get mandatory breaks, so the seemingly 1-2 hour delay waiting for a different resident to be free balloons into a multi-staff scheduling fiasco. We could amortize all those costs into "surgery minutes" which are paid whether or not the literal room is in use or whatever.
It's a math problem if by saving surgery minutes, the hospital saves real economic money for itself, the patient or the state, so I'm not sure if that is or is not the case in your particular case.
What's interesting isn't that there's legislation one way or another, or that you feel like you got a raw deal. The legislation isn't going to change what it says it will, because it will still make sense to hire moonlighters. And motivated people like you will still somehow still wind up paying the cost.
The real test of your merit is whether or not you think in the grand scheme of things, this is fair. Are you frustrated that there may have been a pregnant resident, and that's why there's a moonlighter in the operating room?
What does justice look like there? Cut you a check for thousands of dollars? That never happens. Retribution on residents who might get pregnant? That's what happens.
Your situation is shitty. I know in most movies, books and the press, the doctor is usually the antagonist. We live in a world that resents their disproportionately immigrant backgrounds, disproportionately even gender balance compared to other professions, and most of all their pay, despite their hard work. How do you feel?