Medical equipment pricing is completely broken when a sling costs $200
latimes.com
latimes.com
On top of the nearly $6k in other charges from the hospital, they charged $531 for one dab of superglue or "liquid stitches" on my forehead for something that would have healed by itself.
One of my friends died two years ago from pneumonia. He didn't go to the hospital when symptoms first started because he was afraid of the bills that would come from it.
They don't ask you if you want to spend $500 for a dab of glue on your forehead, they just do it and you're essentially writing them a blank check in the process. I hate our medical system.
It took a lot of reading through the 600+ page plan document and finding loopholes. For example, I asked them that if they thought it should be done for $700, who would actually do it for $700? They couldn't list one provider that would accept the payment rate they thought they should pay. And since this was a reimbursement, and they had already pre-approved the procedure (knowing the price), I think I caught them already saying they would do it, but them not following through. There was a lot of going back and forth about in-network vs out of network, but again, no one in-network would perform the procedure. In the fine print of the plan document, it said if there are no in-network providers, the plan must provide you were in-network rates and deductibles for using an out-of-network provider.
So I told them if they can't find anyone who will accept what they are willing to pay, their figure is obviously wrong. It helped that with my health insurance, everything was supposed to be covered, 100% with no copay. So the fact that they tried to charge me for the $3300 overage was very out of line for them.
They never just said "no, we're not going to cooperate" it was more just endless stalling on their part. It was never really a blunt refusal, or if they tried that, I just proved how ridiculous their arguments were. I kept a lot of documentation.
I think in the end, they just relented because they were spending more dealing with me than actually just paying me my money. But it was certainly an uphill battle the whole way, and not one I would recommend to someone who isn't well versed in legalese.
See also, the TSA precheck systems. By allowing people like frequent flying businessmen and politicians to avoid the standard TSA experience, they reduce the likelihood that such people might use their influence to advocate against the TSA, for the betterment of all passengers.
I was reminded of this just yesterday by a similarly simple story: https://twitter.com/chrisalbon/status/1172161958759395333
It's sort of like "add to cart to see the real price" but they can't say that. And sometimes hospitals are in a different mode where they fight for it. It's not logical, it's screwed up, but anyway the first bill is usually just fake.
See also the US unemployment benefits situation, where many employers will contest an unemployment insurance claim by default even when the worker is actually eligible, in the hopes that some workers will not navigate the bureaucracy well enough to fight back. Because of the weakness of their case, however, they will then back down as soon as their denial is challenged.
https://en.wikipedia.org/wiki/Cyanoacrylate#Medical_and_vete...
I've used off-the-shelf superglue on cut fingertips where I couldn't get bandages to stay. I believe it's also commonly used in place of stitches where you don't want the scarring that stitching would cause (e.g., parts of the face.)
It wears off in 3-4 days.
This is one of the areas that open pricing should help.
I paid $850 at the ER and today I received another bill for $850.
The only thing on the Bill just says
> "Charges": $11,680 > "Adjustmnets: $9,980
I just got off the phone with them and they say that it will take 10 business days to receive an itemized bill. However, that means the itemized bill will be delivered after the current bill is due.
How are they going to charge somebody $1700 without an itemization?
Furthermore, I am expecting another bill from the ER doctor that saw me because they bill separately and are not covered by insurance. The ER legally cant tell you if the doctor or the hospital accepts your insurance. Thats so crazy.
My wife was absolutely mortified. In brazil I never carried insurance but going to the ER I just had to pay R$400 flat fee for a private hospital. Anything else for tests they would give me the prices up front.
My wife about started screaming when the woman brought in the credit card machine while I was still in pain in the ER hospital bed. It was so embarrassing.
All this is with the top insurance my company (a ~$500 million startup) offers and to make it worse it happened when I was on a company mandated trip.
Get on the phone, try to keep cool, but realize you're probably going to yell at some poor customer service rep at some point. Apologize, keep going and get the full bill before you agree to pay anything. Then you gotta do the same thing with the full bill on ever bullshit charge, over and over again.
Honestly, how the fuck can they admit you and treat you and then bill you without telling you what the prices are up front? That's fucking madness right there. Imagine having to agree to having car or bicycle service without an estimate? Imagine the total cost being $2000 over the estimate? Would people pay? Of course not; it's worth it at that point to call a lawyer.
It shouldn’t cost that much in the first place. You shouldn’t need to shop around for health care, and you shouldn’t be bankrupted by an emergency. Why people aren’t marching through the streets right now is beyond me.
https://www.washingtonpost.com/health/uva-has-ruined-us-heal...
We were broke at the time we found out about the pregnancy and memories of the first two years of my boy's life are largely dominated by this kafka-esque nightmare that took time and security away from our family life. I refused to pay a cent until what we were told was honored, my thinking being any sort of payment may legitimize it.
Eventually I didn't hear back from the hospital about our latest contestation for two months after confirming their receipt of the documentation (about a four hour process each submission, always new fax numbers, life-wasting hold times to confirm receipt of said documentation, transfers to other agents and departments, then a promise of giving a decision in a few weeks, often just reprinting the last non-descript document they used in the previous round without any real detail). Decided to just do nothing and ignore it as long as I didn't get contacted again and got everything ready to go to court if someone ever decided to pursue it against us again. The documentation I've been holding from the ordeal is 60 pounds of paper.
I still have no idea what the true status is, but it hasn't shown up on credit checks and our boy is now 5 years old.
I could not find anyone in various governmental institutions to even look into the matter and the lawyers I talked to said the outlook of winning was grim and would have cost a lot of money on top of that to even pursue it. Our insurance company [Anthem] posted a $17 billion profit that year. The hospital had the highest gross profit of any hospital in our city and the surrounding area at $80.4 million declared. Both entities make so much money they give away individual debts amounting in the tens of thousands of dollars for pennies (maybe ours included?).
It's an absolutely depraved system and my point is maybe be careful showing good faith to an entity trying to screw you lest it be taken as consent.
The $42k is a fantasy figure which they collect approximately 0% of the time. It's the easiest $42k you ever saved.
At this stage, it seems like the US is the “land of the free”, whereby “freedom” is defined as the ability to freely exploit everyone.
I am also a British citizen, so I'm at least waiting to see how this whole Brexit thing shakes out.
50 years ago people had the same loyalty towards their companies, and look where that got US manufacturing workers. nowadays you'd be nuts to expect to stick with a company for 10 years. get yours and get out: others be damned.
so it shall be with citizenship. as more and more citizens have more and more power to up and leave, or work outside the confines of the US without too much hassle, questions such as "what on earth are we still doing here?" will be asked, at first in whispers (as they are now), later in louder volumes.
where things go from there, anyone knows.
All medical imaging I've had done has had pricing given up front showing what they where going to bill the insurance company and what the insurance company was going to pay and what I'd have to pay.
My non-emergency visits have a $40 copay up front.
Only the nightmare cases get talked about.
Why would health care be any different?
The number one cause of bankruptcy in the United States:
> "medical expenses"[0]
The average amount charged for an ER visit in the United States:
> between 2008 and 2017, the average price of hospital ER visits rose 135 percent, from $393 to $924[1]
The cost of an ambulance ride in the United States:
> $164/mile[2]
And make sure to compound the monetary cost with the cost of people avoiding medical care out of fear and unknowns surrounding the actual monetary cost.
[0] take your pick of any study done by anyone
[1] https://www.beckershospitalreview.com/finance/average-cost-o...
[2] https://www.consumerreports.org/consumerist/164-per-mile-sur...
The OOP is still averaging under 300, again, not the horror stories in this thread.
Problems exist, but it seems that only a small % of providers are horribly abusing the system.
(of course a small % across over 300 million people is still a lot of harm!)
I don't live in the US and I'm not American so perhaps I'm missing some information.
If the average ER visit was 5K of unknown miscellaneous charges than that would indicate nationwide maliciousness on the part of nearly all hospitals. If only a small # of hospitals are engaging in that level of unfair billing, then they can possibly be investigated one by one.
It is the same thing as "we have thousands servers that are crashing at random multiple times a day" versus "we have a bunch of servers that are low on RAM, and a couple servers that crash 5 times a day."
Neither scenario is good to be in, but it is possible to get a hand on the latter scenario, while in the first scenario a "burn it all down and rewrite" fix might be appropriate.
I agree, though, the masses are exploited (us included), and it’s troubling.
Otherwise most people don't want to leave their friends and family
Note: not defending the horrible system. Only suggesting that most people using their company provided insurance probably don't run into these issues.
https://www.desmoinesregister.com/story/news/health/2017/05/...
I don't know how it's possible, but our healthcare system has been getting worse every year. Even simple stuff like refilling scripts has become Kafka Meets Keystone Kops. The insurer has interjected itself into every single transaction, second guessing everything, adding ever more hoops to jump thru.
It's a wonder that we even bother with doctors any more, since the insurers apparently know better than my doctors.
Things are so bad, I wouldn't even know where to start if anyone wanted to fix things.
Better to just start over.
It'd be far more effective to aggressively regulate hospital billing, wouldn't it?
You should look into the efficiency of medicare and medicaid if you're really worried about this. It might put some of your fears to rest.
This year I had sepsis and had a two week stay in hospital - o dread to think what that would have cost
If you really did just get the bill it will be several months (and several more copies of the bill sent to you) before a final bill would show up that would indicate the account is "PAST DUE" and heading for collections.
IANAL but you can safely wait for the itemized bill.
In the future to save on costs, you might try to find a 24-hour Urgent Care instead of full-fledged ER. Unfortunately the level of equipment that they have to keep in a full ER means just having someone in a bed costs them a lot of money, even if they are just swabbing your throat for a strep test.
Sure, just like you can't charge extra for using a credit card in California as payment in most scenarios (you can get a cash discount though). There may not be late fees, but the hospital will absolutely offer to settle for a hefty discount if you pay ASAP.
By the time you get something claiming "PAST DUE" the hospital may be less willing to negotiate.
Who said anything about getting nothing? If the hospital sells your debt to a collection agency they get something. If the hospital deals with it in house they can act like UVA[1] and sue you to garnish your wages or take out a lien on your property. Playing chicken with the hospital billing department is a bad way to deal with medical debt.
1: https://www.washingtonpost.com/health/uva-has-ruined-us-heal...
Another example was the birth of my child. We prepared for this by setting up an FSA, and having really good PPO coverage that year, supposedly, with a 10% copay. After all the billing shenanigans, my copay was about 30% and well above the out of pocket maximum. How does that happen? You can go to an in-network hospital, and be treated by a mix of providers, all of whom bill separately. Some will be in-network, others will be out of network, so you are in effect deducting against two out of pocket limits.
Medical billing is fraudulent. Medical insurance is fraudulent. These people are all acting in violation of tons of existing laws - I don't understand why this isn't prosecuted.
Wouldn't it be fun if whenever somebody criticizes their government, they also state who they voted for to force them to open their eyes to the fact that it's their own fault.
People rationalize it by saying that voting for a 3rd party is "wasting" their vote, but in that sense, voting for anybody is wasting their vote because it never comes down to one individual's vote deciding things. Really they just have two driving forces - allegiance to whatever tribe they randomly found themselves feeling like a part of (and mysteriously agree with all the inconsistent aims of), and wanting to be on the winning team. Healthcare be damned.
Without a switch to range voting, approval voting, or one of the condorcet variants, the party system will remain broken into two corrupt halves.
In reality, voting for someone who didn't win the election is a "wasted" vote. But people will say that a particular candidate has no chance of winning the election, so voting for them is "wasting" your vote. Unfortunately, because most people follow this line of reasoning, it becomes a self fulfilling prophecy.
I guess I am stubborn but I will never vote for one of the two big parties. However it would be great if smaller parties got some kind of representation in Congress. It seems ridiculous that in the 90s Ross Perot got 20% of the vote but that resulted in zero representation.
Also, I find it curious that while our community has generally settled on "incremental improvement" approach, we expect different from our governments and want the "big bang" changes. Then we are surprised when things get worse.
It’s not. It sends a signal that there is a desire for something else.
The public memory is so short and so malleable, people forget things week over week let alone the entirety of an election cycle.
The issue with third party voting is a classic case of the problem of coordinated collective action.
Would-be voters don't participate out of perceived futility or participate in the dual party system for similar reasons.
I don't know how to solve it but there does seem to be growing agitation in the electorate with the current system as it stands, with the Electoral College under public scrutiny and with media support. To me that is a signal that times are changing.
It's actually worse than what people say. First past the post voting systems have a lot of problems, one of which is called the spoiler effect. By not voting for the major party you prefer you are actually voting against said major party.
Take this simple example: Major party A has 51% of the votes, while major party B hast 49%. Party A wins the election. Next election party C makes a big campaign at party A voters and convinces 3% to vote for them. Now we have A 48%, B 49% and C 3%. Party B wins the election. And if we look at the paper trails it probably doesn't surprise who funded party C's campaign.
Assigning this well studied behaviour of rational voters to simple tribalism is trivialising the core issue in the US: Elected officials are not representing the people. The way to fix this issue is to fix their voting system.
Simply examine the way the issue was presented by frontrunners in the supposedly liberal party of the United States on the debate stage yesterday.
Two candidates call for true universal coverage, a few call for a public option but brand it as universal coverage to confuse viewers, and several (with moderator and broadcast sponsor support) outright mislead by stating that universal coverage that eliminates private insurance will threaten access to health care.
We have a long way to go.
...
Loss aversion is a powerful emotion with destructive effects on our politics.
Once enough people have something to lose from a change, change becomes extremely hard, even if the overall net effect would be positive.
Not only does this preserve bad policies, it turns some into a one-way ratchet--where it's easy to make things worse and very hard to make them better.
Examples
- Medical middlemen (insurance, insurance brokers, billing companies...) are pure waste. But they employ so many people and generate so much revenue that they are very hard to attack. The US has slowly climbed to ~2x the per-person medical spending of our peers... so now, any effort to reduce that to 1.9x will be met with fierce resistance.
- Prison guard unions are powerful nationally and in many states, including California. They fight any and all attempts to reduce incarceration. That was true in 1980 with ~100 prisoners per 100k population... and it's true now with ~650, by far the highest in the world.
- Realtors and car dealers essentially tax the two biggest purchases most people in America make, house and car. They have powerful lobbies in all 50 states.
There is no particular amount that will placate these rent-seekers. They just never want their income stream reduced.
Both parties are economically right wing. Third party is easily squished by tribalism and system being unbalanced.
If private insurance was allowed (in Canada), the elite would have expensive plans that had physicians only caring for a few people each, and so on. This worsens the care in the general system but more importantly, it splits the interests of the elite from the general public.
Becuase that's where I get stuck.
Specialized illnesses don’t discriminate by class. Those without means don’t receive the care they need. We are fighting so that the system centers that care instead of revolving around a third party private payer that has every incentive to deny that care.
From a less selfish perspective, there but for the grace of God go you.
Hoy por ti, mañana por mi.
But they would never be able to outcompete it.
Imagine if every time you went grocery shopping you had to pay for the people stocking the shelves, putting the carts back if you used one, the cashier, and each wholesale distributor. It's crazy and senseless. Just the way they like it so they can get away with so much more.
Well, yeah, that's true by the definition of “subcontractor”, which doctors in hospitals often are not.
OTOH, healthcare isn't the only place where you might pay a fee to a facility for use of the facility and a fee to a service providers associated with the facility for services they provide in the facility. It's perhaps an inconvenient arrangement, but by no means unique.
Where else does this occur?
BUT STILL, weddings are a really bad example here.
The people getting married get to chose from whom they want the table and chair covers, flowers, singer/band, catering, belly dancers/entertainment, lights people, AV people.
Those are choices you got to make and the bills will obviously come separate since there is clear distinction of entities. Heck, the venue and the singers might not even of said a word to each other, let alone have a billing agreement.
Event facilities (for weddings, etc.) often have established partners for various event services that you pay directly rather than through the facility, which you also rent.
Dance studios where the dance instructor is affiliated but not an employee of the studio (especially where the affiliation is non-exclusive) will sometimes (especially for private lessons rather than group classes) charge a floor fee which you will pay to the studio, while the instructor is paid directly.
Fairs, etc., often charge you a gate fee, while you pay for goods and services inside to vendors directly (which vendors are also paying the fair for the privilege of being there, too.)
Arguably, residential real estate leases without included utilities is a closer analogy than any of those: there are a number of non-optional service providers you pay separately, on top of paying the landlord to occupy the premises.
"For those who are not familiar with the Kaiser system, here is a very abbreviated explanation. Kaiser Permanente is an HMO, and consists of the Kaiser Foundation Health Plan (the Kaiser insurance) and the Permanente Medical Groups (the Kaiser doctors). The patients buy the Kaiser insurance and they are only allowed to see Kaiser doctors. The Kaiser doctors are salaried from the pool of insurance premiums and provide service only to the Kaiser patients. In the Kaiser model, services are prepaid, so there is no financial incentive or penalty to providing or receiving medical care."
But businesses and some consumers do want things to be under one roof - no surprises on in vs out of network, they don't like separate bills from each doctor that sees them, easy referrals, etc.
Kaiser is sort of a funny workaround.
The Kaiser Foundation Health Plan, the Kaiser Foundation of Hospitals and The Permanente Medical Group = Kaiser Permanente
The win for the patient is everything in-network and under one roof. If you are in a Kaiser facility EVERYONE is basically in network (with the exception of some state mandated providers that have to go through their own state flows - yes, that's why sometimes you need to repeat info on forms even at Kaiser)
The win for doctors is you really don't have denied claims or the billing pain you might in private practice.
CMA I think has really fought these setups before, but now oddly (in part because of medical malpractice and EHR overheads etc) working for Kaiser isn't considered a dump job anymore.
Bad news, obamacare put demand through the roof at Kaiser (even though they are not the cheapest plan) so they are shortstaffed I think.
If you do or know anything about medical billing - medical providers probably hate it as much as you do. A patient with primary coverage through Kaiser and secondary through Medi-cal - just to bill Medi-cal for $40 - you could spend hours on that as you hoop jump.
...why?
Most (all?) states forbid whats called the "Corporate Practice of Medicine." The idea is that profit motive of a corporation can lead the corporation to manage physicians contrary to the interests of their patients. To mitigate this, states only allow certain business models for physicians:
* Sole Proprietorships - they can work for them selves
* Professional Corporations - a restricted sort of corporation that requires all shareholders and executives to hold a license for the profession the corporation practices (ie, they all must be physicians)
* Some states have exceptions for research universities, public hospitals, non-profits, and other sorts of organizations.
The exact restrictions of course vary from state to state. Here's a state-by-state rundown: [1]
Its my understanding that analogous restrictions are common for other licensed professions such as law and accounting, but I know much less there.
[1]: http://archive.healthlawyers.org/google/health_law_archive/p...
Dignity Health deserves a special mention though. They obfuscate their billing as much as possible. The initial bill indicated they'd give me a cash discount and wanted something like $2500. Then they sent me another bill for $1800 if I paid promptly, with lots of weasel words to make it seem like I really owed more than $1800. So, of course I paid but I had no real idea if $1800 would be sufficient (in fact their online payment portal hinted it wouldn't be). The best part was getting a survey about the quality of their billing statements right after.
$$$$$$.
The Medical system is being used to transfer wealth from the working and middle classes to the capital class under the guise of "free market". That money is being used to shape legislation, buy politicians, influence elections and kill threats to the system, allowing for even greater wealth transfer.
The rigged markets of socialist Europe are far more transparent, fairer and free, whereas our "free market" is opaque, completely unfair, totally impossible to understand and offers very little in terms of real free market choice. Yet we are brainwashed to think that our system is superior, due to the propaganda the industry pumps out.
Second, I would require that all medical products and services must have their prices acknowledged by the consumer before service is rendered. Obviously there would have to be some exceptions for extreme medical emergencies, but emergency care only makes up about 1% of healthcare costs, so that can slide.
I would disband medical unions such as the AMA, which spent decades artificially limiting supply of medical workers to keep wages sky high.
I would ban employer provided health insurance, decoupling healthcare from employment.
I would attempt to reshape the health insurance industry to actually work like insurance instead of total coverage. If you get the sniffles, just pay the market rate to visit the NP at the CVS minute clinic, get your antibiotic or whatever, and be on your way. Insurance should not be involved in that, and should be reserved for major medical emergencies or serious conditions like cancer.
I would have serious patent reform, moving pharmaceuticals to generics at a faster rate, and expedite FDA certification for generics. I would work to create a system of partner countries for healthcare certification. If your drug is approved in France, you get a greatly expedited process in the US and vice versa.
If those things didn't dramatically bring down the price of healthcare to a reasonable rate, then I'd consider some socialization of risk.
I'd like to understand why healthcare doesn't bill using time & materials plus markup. All current pricing seems little more than make believe.
I also don't understand why different people are billed different prices. I get that different providers will likely (hopefully) have different billing rates. But isn't billing different prices for the exact same thing illegal?
I'm going through this now! It is completely baffling! I went to the ER, and then I received a steady stream of bills over a period of months. They were so numerous and so devoid of useful context that I began to worry that they were illegitimate. The billing process is absolutely insane.
Oh, America, you will never change.
For many procedures, we’ve just been avoiding going to the doctors. Doctors have been a hit and miss too. Most really don’t know what they’re talking about.
I’m kinda hopeful that someone will really commoditize common procedures and checks and will make them dirt cheap. May be amazon. Can’t say.
But shit like LapCorp and a whole swath of vulture physicians and insurance companies need to die.
US healthcare is really fucked up.
https://www.uhc.com/employer/news/consultant/irs-sets-new-20...
https://www.cigna.com/assets/docs/about-cigna/informed-on-re...
But I’ve never heard of a deductible actually being set equal to out of pocket maximum or even anything close to it. Even the bronze family plans on healthcare.gov had deductibles of a few thousand.
Most people would be surprised how closely hospitals and other medical companies pay attention to their social media and Google alerts.
I'm less concerned if they're scamming the insurance (although I'm existentially and politically interested) than billing of individuals.
Z176 - Repair of lacerations - up to 5 cm = $20.00 Note: Wound closure via tissue adhesives (such as cyanoacrylate) is payable at 50% of the appropriate fee.
Meaning, in Ontario, your procedure would have cost us $10. I'd have to look through to see what other costs would be incurred for the ER visit, but suffice it to say, it's probably well under $6,000.
Oh, and that's $10 CAD, which is like 2 Freedom Bucks. ($7.52 USD)
I was once charged $1,500 for a doctor to talk to me (without ever touching my physical body) to “prescribe” me over the counter motrin....
I then questioned them on this and they said “well it was a prescription” : i said you never even physically touched me. “So im going to tell you what this was worth to me: $50”
They then said “okay we will charge you $297 for the visit”
I said “you made me wait over 45 minites before even seeingg me, at 9:00 pm when i was the only person in the waiting room. NO; im am going to charge YOU $50 for my time wasted”
The dropped the entire bill completely.
Good samaritan hospital in los gatos ca.
(Where my grandmother worked for decades, and after el camino hospital bout them and i was the technology designer for their upgrade)
You can negotiate codes with hospitals.
Source: i have built more than ten hospitals; el camino, good sam, ucsf, nome, sequoia , zucks sf gen, etc...
Dont let their coding depts fuck with you - take a stand.
Frankly you should challenge every single hospital charge you ever receive, they will always go lower.
As an example, just two weeks ago I made an appointment to go see a doctor. They called me back (kaiser) and said “ just come into the ER”
I said why, they said I don’t know, that’s what they told me to tell you.
So I called and verified my copay $30 and coverage etc.
When I got there they took my blood pressure asked a few questions, and then gave me the prescription I was asking for.
When I went to pay they tried to charge me $250
I said fuck you, I called and made an appointment, my co pay is $30 so that’s all I’m paying you period.
They conceded and accepted.
A world where 100% of Americans are covered under the existing healthcare system is still a disaster because everything still costs so much between premiums, deductibles, copays and coinsurance. And on top of that, patient responsibility is still largely unknown until post treatment.
If you look at the cheapest Bronze plans on the Obamacare market, you're probably looking at $400/month for the premium with a $7500+ deducible for a single person. If someone is coerced into buying insurance and they can barely afford the premium, how is that something worth celebrating?
In the UK, I could walk into a Boots (pharmacy), speak to someone there and get prescription eyedrops for cheap for an infection vs the crap you have to wade through in the US. Same for other doctor/healthcare visits I've had around the rest of the world.
Go to the hospital, let them bill you, and then throw the bills in the trash.
And you can wipe out all of it by filing bankruptcy.
Is it possible that they cannot garnish wages in your state? Where are you getting your information?
Similar to your situation, I went to a dermatologist concerned about a bump. Turned out to be a skin tag which she cheerily said "We can take care of this right now" and snipped. That snip cost $250 (wasn't on the genitals but was close enough for them to bump up the cost). I called their billing company and spoke to their office manager. She said that "the doctor just wants to make sure customers are happy and doesn't really concern herself with the billing part" when I brought up that if something is going to cost something they should say so upfront if it's something not necessary.
Thanks for the heads up about the glue. They really do take advantage even when you're a bad situation.
And guess what they won't ever vote for: Those of us younger than 65 ever having the same luxury. We may be visiting them in the hospital every day, but they don't really see us.
And it's hard, because our generation loves them and wants the best for them, but most of us know we won't ever get the same quality of care for ourselves unless something changes...and as a human, well, you know, you get kinda bitter counting up "Wow, this is awesome, but what would it cost if I had this happen to me?"
Vote, people, because if our elderly are getting state-of-the-art amazing life-saving care, why shouldn't our young people, upon which our economy depends, be getting the same great service?
I try not to get too bitter about it, though, because their great coverage means we don't go bankrupt trying to help them: we're very lucky for that (although eldercare is a whole other ball of wax)...
It just kills me to see all of these young people begging on GoFundMe just to afford insulin -- and dying! Over insulin! -- while it's stockpiling pretty nicely in Medicare-recipients' closets thanks to overzealous pharmacies that know Medicare will pay for whatever they keep shipping, and seeing young people cobbling together their own makeshift slings for broken bones while so many nonagenarians are technically part-robot thanks to Medicare's great coverage.
I was hit with a bill for over $10K, with much of that falling on me.
I also used to work in corporate finance and I have a good intuition for how billing works.
Before I even got the bill I mentally prepared myself for it by telling myself that it's going to be a long drawn out process.
I waited and waited and received an initial bill a few months after my hospitalization. It was for the aforementioned amount.
I called and politely asked to have it itemized. Naturally,that took several more months.
The bill was reduced, but the itemization was incorrect, so I asked for a correct itemization.
I went through a few more iterations of this. Each time the bill got lower and lower.
Eventually, I had to pay something like $1.5K out of pocket, which would have been a lot less if I didn't have an HSA.
The whole process took almost a year.
If you ever have to go to the hospital, just assume that it will take forever and nitpick the bill (within reason) and continue to challenge it. They will often give up and reduce your bill. Whatever you do, never pay a bill that is not itemized. As a former finance professional I am shocked that hospitals can get away with this, this would never fly in the B2B world, professionals always push back against "mystery bills" that show just the bottom line number.
In either case, what reference do you use to ascertain correctness? I feel like information asymmetry is a problem for a lot of patients. It's hard to tell if you actually need a treatment, or if you're being charged fairly for it.
Also reminds me of unplanned importation fees. Transporter started to send me letters after letters. I bounced emails as long as possible asking for some explanation. After a few months and a few lawyer agencies (mind you it was just a few SBC bought online) they accepted to make me pay for a much smaller amount, sending me the same bill but with an added line "deal rebate" and that was it.
I wonder how much money get lost this way...
After giving birth my wife was offered Ibuprofen. On the bill we were charged $80 for the 2 pills she took. This was before Obamacare.
After Obamacare I twisted my ankle and the doctors insisted I wear a cheap fabric boot with stiff plastic plates while it healed over the next couple weeks. I asked how much it cost and they said $280. I took it off and refused it while they gave me dirty looks.
A medical facility is basically a monopoly. The switching costs are high and there are no prices on anything.
Unfortunately getting everyone insurance was only the tip of the iceberg of the actual problem. We still have a long, long way to go before we have real, competitive medical pricing with high quality care.
https://fightthefuture.org/article/returning-to-america-and-...
If everyone was forced onto healthcare.gov, there would be enough healthy lives to offset costs from sick lives to create an effective market.
Someone I know sprained their ankle. They recommended that he should use a cane for a while and said they had one to give him. When the bill came weeks later it was $200 for the cane that looked really close to what you can get for $20 at Walmart.
The really messed up thing is I drove him to the doctor and I carried some of the paperwork out (wasn't the bill) so he could use both hands to move around safely. When I was outside I held the piece of paper up and a gust of wind bent the paper in such a way that I ended up with a really nasty paper cut. Like a 2 inch slice on the inside of my finger. One of the worst paper cuts I've ever gotten.
So I went back into the medical center and I asked them if I could get a band-aid. They asked why, so I explained. I got a few smirks from them (they borderline laughed in my face) and they told me that they weren't allowed to give away medical supplies and that I should go a few blocks away to a CVS (a local drug store). Meanwhile just to be insured costs $450 / month for the bare minimum (which I don't pay for but I've payed many thousands in fines for not having insurance).
I'm shocked they could give you a price. Anytime I ask for a price it takes hours of talking to multiple people spread across several days.
I had to pay for parking.
Once he was back at school, the school district brought out occupational therapists who assessed his new disability and provided extra assistance while he was wheeling around.
He has had four follow-up visits with the orthopedic specialist. In a month or two he will have another surgery to have the rods removed.
I will then have to pay for parking again.
Welcome to Canada.
That was the time I understood how lucky we are, when the final diagnostic fell, it was the first thing that came to my mind, what would have they done if it wasn't free... they would have to decide whether they try to give her a few more years and pay hundred thousands, or just watch her suffer a few more months. Sadly even with the amazing care she got, she died less than a year later, but at least they got that time and they never had to worry about the cost of it.
My credit score is great in the 740+ range.
I know big stuff they could take me to court or put a lien on my property. They haven’t yet.
It’s my little protest against all of this crazy healthcare prices and system we have here in the US.
If somebody from the hospital had told me _before_ I got served that I could get 85% of my bill written off just by submitting some paystubs, I would have appreciated it. If you're in a similar spot, call and ask about patient financial assistance or similar programs.
Also, if you had to go to an emergency room, would you give them fake personal info so they can't send you bills?
I mean I can ask my dentist how much it’s going to be and he can actually give me a price before my procedure.
But as I stated above the insurance pays their portion so it’s not like nothing is being paid. Just not the 900% markup.
I don’t recommend doing this. I’m sure it will bite me eventually but it’s been 10+ years. And yes I haven’t had any major or catastrophic medical event in my life. So the bills haven’t been in the +10k range. I’m pretty sure once it gets there they will put a lien or sue me.
I go the same facility every time. I haven’t been denied. My family hasn’t been denied.
If I did go to an ER for something serious I would give them my real name and info. I do have insurance and it will pay a portion. Depending on the size I might pay it. I might not. Just haven’t had anything really large.
I'm definitely not defending hospitals and most doctor's offices but I think that plays some part in it. There's also a decent amount of dental competition when it comes to routine work such as cleanings, so prices wind up staying somewhat reasonable where as with a hospital there's no competition really due to how insurance works.
Develop a good-quality fake identity purely for skipping on medical bills.
Just to add an alternative that I've considered (now being a kind of programmer emeritus) is to go into a full-tilt asset hiding mode. There's just too many ways to lose your hoard of cash.
I asked how much it would cost. They said they were not ALLOWED to tell me. Which is different than not knowing. I told them what insurance I had. They said many people came in with that insurance. I asked how much of the procedure is normally covered. Also apparently a secret.
I just can't see how it's legal to bill someone for services received while refusing to give information on what it will cost. If the bill had been $50k what recourse would I have had?
Gas goes up a quarter and elected officials are thrown out of office. $600 for a drop of super glue? Okay then.
And that of course is part of the problem. Medical billing is like playing numberwang or who's line is it anyway. No two numbers on a bill seem to be correlated in any way to another except as upper or lower bounds.
When someone without coverage comes in then, they have to play that stupid game with all the numbers, and of course they either ignore it and go into debt, pay the cash price if they're able, or they manage to negotiate it down by orders of magnitude - proving the price didn't matter anyway.
https://www.medicaid.gov/medicaid/finance/dsh/index.html
It’s just another case where the government splits spending across multiple programs.
> Hospitals with above average Medicare patients generally get paid more than the general population.
And the added payment isn’t that much.
Generally Medicaid pays below cost. Medicare is reasonable and leaves providers with a small profit (single digit percentage).
From 2015 to 2017 Medicare lowered it’s uncompensated care payments. However, that program covers uncompensated care underpayment. Medicare explicitly does not pay for everything at hospitals: https://www.medicare.gov/coverage/inpatient-hospital-care
Or, more likely, simple way to force hospitals to make drastic cuts to services.
lol. Seriously? Well it's a simple system.
I wonder what happens when it's Medicare-for-all. Do they make 1/8 as much all of a sudden?
Meaning, while most Canadians do not know what our healthcare actually costs, it's all itemized, standardized, and freely available.
I just looked it up and was surprised to see that C-sections are only about $80 more than vaginal delivery (we just had a kid), so it's nice to know that there isn't much incentive for doctors to push one over the other. I realize that's a gross oversimplification, since there's probably a lot of other billing codes that get tacked for surgeries.
A few weeks later we had our son’s ashes and a $148,000 bill.
We lost our first, and er visit costed us much less. Few thousands... Didnt have the energy to fight that time...
We had insurance so we didn’t pay that crazy amount but it’s just absurd what these places charge.
I am willing to fight, even though my out of pocket is also very small.
This is the only country in the world where there are people who will divorce on their hospital death bed, because they are so fearful of the financial impact on their remaining family.
And a non-insignificant part of the population finds this acceptable because they see the alternative as "the government treading on me".
As a German, you don’t have to spend any brain cycles on health insurance or medical costs. If you’re self-employed, you maybe need to think about getting private insurance. Besides that: health care is just there for you. You don’t have to pay almost anything from your own pocket (besides glasses and some depending on the age).
The financial aspects usually can’t ruin you. Prices are "normal". I had a US friend over a while back. She had a tooth ache. The dentist fixed it and the bill was like 180 bucks or so. She couldn’t believe how cheap it was compared to the US. And this wasn’t some shitty job with inferior materials or whatever.
Total bill so far: £2 parking. Also the coffee machine in the relatives waiting room was out of sugar.
Dreams aside, in order to have a free market healthcare, which is what informed libertarians want, you need to abolish medical license, the FDA, patents and many other State's interventions. There is a reason why the healthcare system in the US is insane, and it's because the laws are made so that cronies have the monopoly on your health. Neocons are pathetic when they defend the current system.
Without the free market (the real one, not the scam you have in the US), healthcare will be a mess more than any other industry and at that point is better to have a single payer, universal system, because in the end they have the same problems of the current US system but at least you don't get ruined.
How can a market like this exist when the buyer is incapacitated, not to mention even when not incapacitated, the buyer is not sufficiently educated to understand what they are buying?
Also, supposedly people aren't total dicks. At the moment the healthcare industry rewards a lot of psychos due to its incentives. Hopefully with a free market the dicks would be weeded out due to increased choices. Also having a free market means that there would be an incentive to make medicine more accessible, while still correct, because more people could be willing to become healers, maybe specialized healers. Who knows, what's certain is that we have not discovered the full potential of humans healing other humans and the current regulations are a big brake on new systems and innovations.
So, for now I'm ok with the whole single-payer/universal healthcare deal.
Good luck to your dad, wishing him a speedy recovery as I also sit next to my loved one also on a ventilator and in a medically induced coma as their brain recovers from the large hematoma left behind from the stroke.
Being in a situation like this really makes me come to terms with my own mortality and how short life truly is in the grand scheme of things. I think I'm going to start volunteering to help those in need and donate my time and professional skillset to nonprofits as a result. Good luck with everything friend.
The correct way to sell this to the populace is probably by framing it as a "minimum standard of service for all", and "getting the full value out of your taxes".
This is pretty infuriating given that the article previously said that Breg directly billed the patient in a "surprise billing".
A company with seemingly no connection to the hospital directly bills the patient $200 for a $12 item and then when asked about this by a journalist says "We don't sell direct to patients" and refuses all further comment.
If they don't ever sell direct to patients then the bill must be fraudulent, sent by an imposter.
Curiously enough last year I received one of these sorts of fraudulent scam bills. A traffic camera ticket. It had my name but no street identified, no license plate or car description, no drivers license number, and no photo of the alleged infraction. The mailing address was to a location far away from the city, neither location which I had driven in recently, and the company I was supposed to write the check to didn't have a lot of information about who they were online. I was not allowed to contest it unless I signed an agreement to accept private arbitration results. I went to the city it allegedly came from and asked at their courthouse about it and the clerk told me "You are required to pay this" but said she was not able to verify anything about the ticket, give me a license plate number, or the name of an intersection or photograph, referring me instead to the arbitration and saying that "privacy laws" prevented her from saying anything else. So I didn't pay it, ignored it and never heard about it again. As far as I'm concerned it was a scam. If it really came from the city it was unconstitutional because there was no due process. It also wasn't served, it was mailed bulk rate and not even registered, which such mailing is not a valid server process in this jurisdiction.
Given that this company Breg says they don't sell to patients, the patient has a legal basis for refusing to pay this bill claiming to be sent from them, because the company itself has claimed in an official statement to a journalist that the bill is fraudulent.
Sounds like they were in on the scam. What would be the appropriate method to legally-resolve this and shut it down?
Contact the state's Attorney General?
Of course, that was just a minor component of the final $50,000 bill ($4k for me after insurance), but it still sticks out in my mind many years later because it was an easily comparable baseline.
Health insurance companies get alot of the blame for the broken healthcare system in America but I place most of it on the providers - doctors, hospitals, and drug companies. They bill an order of magnitude too much. Sometimes more. Attacking doctors seems to be a much less politically palatable option than attacking big insurance corporations, even though those doctors are essentially gouging their loyal patients with no qualms about it.
Had taken him to Stanford Emergency, he got a a cast and a really cheap sling.
Received a bill from a Texas based company, don't remember the name, for about $200-$300, for the sling. Looked online, there were bunch of BBB reviews about this, including about calling them where the issue was settled. Same sling on Alibaba.com was $1-$2.
I called them up. I was told we were out-of-network for the sling, even though Stanford hospital was in-network. However, since we were in CA, we are kinda protected if we don't know this (in/out of network) in an emergency room.
I had the option of asking Stanford and insurance company to refile, or pay them $20 (from original invoice of $200-$300). I paid them $20 to settle the claim.
Plenty of people are up for changing it. It is quite literally the center of a huge debate at the moment in the Democratic primary, and there is a broad spectrum of changes being proposed, from Medicare for all with price controls to a slightly modified Obamacare. Only one candidate among those more or less supports the status-quo.
And the Republican party is currently avoiding discussing the way they'd like to change the health system (repealing Obamacare, fee for service care) because it isn't particularly popular at the moment.
Meanwhile, stories like the ones you see piling up in this thread happen every day.
Are you so sure about that? A republican president recently signed an executive order for more transparent pricing:
https://www.npr.org/sections/health-shots/2019/06/24/7355785...
But that's smart actually. They correctly realize that it is political suicide to run on taking health protections away from people at this time.
As much as I despise Trump, this idea wasn't terrible. Obamacare/ACA was only a stepping stone. But the republicans had a 'talking' with him.
https://www.npr.org/2019/04/02/709175203/trump-backs-off-oba...
After insurance paid its portion, I got a bill for $800 in out-of-pocket charges.
Generally really good insurance has a 10% co-insurance charge. But the first $X amount is entirely borne by you.
I called the surgical center, and was told it was a flat fee of $500, payable in advance, for which I received a receipt: "Facility fee".
We did the surgery. The doctor's bill was well under a thousand dollars.
Almost six months later, the surgical center sent a bill to my insurance for $48,000 as a half-dozen line items, each listed as "facility fee". My insurance says they paid $25,000 and the patient responsibility of about $10,000.
We haven't seen a bill from the surgical center, and I told the insurance it was either a billing error or fraud, as it was 100x the price I was quoted and accepted up-front.
>My wife has Stage IV breast cancer. She has been a public school teacher for 20 years and we have pretty good health insurance. She continues to work. She will teach as long as she can because she wants to...and financially she will need to.
>Even with good health coverage, we have STILL spent thousands of dollars the past couple years out of pocket. If/when she takes medical retirement, it will get much worse. It will cost her 75% of her retirement income just to purchase health insurance. The rest will go to copays, gas for hospital trips, etc. Oh by the way, we still pay thousands in federal taxes each year, while corporations and the rich avoid most taxes and pay very little. It's fucking criminal. Fuck everyone who developed this system and fights to maintain it.
From this thread on medical bankruptcy being a uniquely American phenomena: https://www.reddit.com/r/politics/comments/d10ab6/medical_ba...
I see people say this, but what does this mean? Should we not certify our doctors? Should just about anyone be able to hang out their shingle?
https://www.huffpost.com/entry/who-pays-for-resident-sal_b_1...
Another thing would be to expand the scope of nurse practitioners where it makes sense.
The Kaiser system would be great if every major hospital nationwide was under it. Kind of like a national healthcare system...
""" Under state law, the practice of “balance billing” — sending a bill to a patient if his or her insurance company doesn’t pay the full requested amount — is illegal for people insured through a health maintenance organization. Kaiser is an example of an HMO, a network of doctors that supplies services to its members. """
That said, a lot of the reason the specialists costs are lower at Kaiser than other offices is because they don't all have their own little office and staff. Many specialists in the US are expensive because they have to have a secretary and an accountant, etc. At Kaiser they are just part of the system, so the costs look a lot lower.
Amazon sling is $12.99 to $16.99 according to the article.
So hospital sling is 12-15 times more expensive.
So I suspect that the original writer of the article correctly wrote that hospital sling is 10 times more expensive.
Then the editor came and decided that 10 times more expensive looks not as scandalous as 900% more expensive.
The result is false precision https://en.wikipedia.org/wiki/False_precision and bad journalism.
If they had taken the $12.99 price (an actual exact price, with 4 actual significant figures of precision), the $200 bill (also an actual price paid, with five significant figures of precision) is actually, really-not-false-precisely, 1440% more expensive than amazon.
They allowed in the article that the sling might be a bit nicer than the ones on amazon - it had some padding. So they rounded its value up to roughly $20, giving, as you suggest, 10 times more expensive, as an estimated factor. Let's assume that's only good to one sig fig. That's fine for an estimate, and consistent with the 'probably worth a bit more than the ones on Amazon, let's say somewhere between $16 and $25' methodology.
"900% more expensive" is a perfectly accurate restatement of "10 times as expensive" to a single significant figure. Would you rather they went with "1000% more expensive" to make it feel more Benford's-law-comliant in its imprecision? That would surely have helped your supposed sensationalist editor, right?
"900% more expensive" is literally just another way of writing "ten times as expensive".
So I really don't know what kind of editorial sensationalism conspiracy you are trying to posit here. Wouldn't a sensationalist have gone with the 1440%, and nefariously rounded it up to 1500% to punch up the headline?
This seems like a weak place to try to hang an argument about the innumeracy of the press....
No, it is not.
Same way as "ten times more expensive" is not the same as "10.000000 times more expensive".
Using percentages here implies high precision.
> Would you rather they went with "1000% more expensive"
"10 times more expensive" sound just right.
> I really don't know what kind of editorial sensationalism conspiracy you are trying to posit here.
Sorry, no sensation here. Just false precision which is a bad sign.
This is one of the key problems with the US healthcare system and why talk of this or that insurance scheme (regardless of content) is absolutely ridiculous.
To use a parallel, it's like talking about selling a $10 burger for less without changing the underlying cost structure that causes a burger to have to be sold for $10.
Anyone who proposes a "new and improved" insurance scheme betrays an utter lack of understanding of the most fundamental of concepts: If you don't do a thing about baseline costs there is no insurance-based solution that can ever "fix" the problem.
This means taking a very hard look at the cost (in time and money) of the regulatory burden as well as the other element of that cost structure: Tort reform. Both of those factors increase the cost of absolutely everything even remotely related to the medical industry. Fix that first and then medical insurance will magically become cheaper and better.
That’s probably what they would do. We know that they don’t base prices in any kind of rationally economic way.
Just like a proper capitalist system! You know, like when you agreed to pay whatever for your iPhone prior to even know it'll work.
I can contact Apple for help with any issues I have with my iPhone. I can contact my carrier for any issues I have with my iPhone. I can return my iPhone within a grace period if I don't like it.
Try doing any of that for medical costs.
I know these won't actually succeed in adding a bit of capitalism but it does succeed in highlighting the absurdity.
Other than pedantry, what are you trying to get across?
Anyways. In the itemized bill they charge about $40 per ibuprofen. If we knew the price, we should have brought our own and just rejected theirs.
Someone might come along and reply with that $40 covers nurse salary, tracking the medicine etc. Yeah... Bull$hit.
Here in the UK, my wife's breast feeding help consisted of an inexperienced midwife (possibly only a trainee), awkwardly being remarkably unhelpful.
Also, since my wife has had surgery to remove a benign tumor in her breast, lactation consultation was covered the first time. No idea WTF happened the second time. This is the US medical system for you.
I'd also like to add we received a random bill for our first daughter 2 years later. No idea what it was, but the insurance covered all of it so I didn't care.
The fact is that hospitals aren't built for itemized bills because very few patients pay the posted prices out of pocket. Medical debt is extremely hard to recover in the US, so why bother expending the resources to figure out a sensible pricing structure for a small minority of your customers who mostly aren't going to pay that price anyway?
Hospitals seem to have done an amazing job of charging just enough after insurance for the upper/middle class to be willing to pay to avoid hurting their credit scores, but so much that everybody else just doesn't pay and files for bankruptcy if anybody ever comes after them.
We went home and she ordered 5 pairs online for $50. The anti-reflective coating cost $90 at Kaiser, but only $6 online.
Fortunately, I don't wear glasses.
Warby parker, zenni, etc are the disruptors.
Reading things like this, stories in this thread, and about how people are avoiding seeing the doctor because they're afraid of the bills ... makes me realize in some ways Thai people actually have a higher quality of life than many in US in this respect.
Costs are order of magnitude(s) lower. A night in the hospital is typically 5,000-10,000 baht or $166-$333. And the quality of care is at a good standard .. so much so that Thailand has become a Medical Tourism destination:
https://www.health-tourism.com/thailand-medical-tourism/
If you have some money, you can pay more for faster service and more attentive care at more expensive private hospitals.
And if you can't pay, you are still covered by Thailand's Universal Healthcare:
"What Thailand can teach the world about universal healthcare" https://www.theguardian.com/health-revolution/2016/may/24/th...
"Thailand: At the forefront of Universal Health Coverage" https://medium.com/health-for-all/thailand-at-the-forefront-...
Thailand is a relatively poor country, but we are still able to do this. In the US, I guess some people would rather die than admit needing help from the government ... or trying to clamp down on healthcare costs cause it would be too much 'regulation'?
They do this in the UK for getting dental treatment in Eastern Europe where fillings can cost €20 each.
I believe this is false. Healthcare quality is basically the same in all first-world countries, the only difference is cost structure. (My wife had a c-section in Germany and our total cost was about 100 euros for an optional private room.)
While this statement is correct, my understanding is that there are still small quality differences, and the US is in fact the word leader in quality. Thinking about it, this also makes sense – if you are willing to pay extreme amounts to doctors, you should also see at least some improvements in quality.
But we are talking something like <1% better quality for +100% the cost, so this is clearly not worth it. But if I was a billionaire with a difficult disease, I would definitely at least consider going to the US for treatment.
> they dispense the product on Breg’s behalf and Breg follows up with its own bill.
My intuition tells me that this relationship may have generated a little side hustle for the hospital, which if it really occurred would be extremely illegal. That reporter should dig a little more.
I can't imagine it is quite the scrooge mcduck caricature where the people reaping these profits are literally trying to defraud people. I would love to talk to a health insurance insider or something and ask them to justify this stuff.
Mostly our healthcare system is completely fucked and we should all feel bad.
There's not much incentive to create a sensible pricing structure because very few patients actually pay the posted prices. Most revenue comes from the government or insurers, and neither of them give a fuck what you charge for a sling. Hospitals have limited resources, and dealing with insurers is a big enough operation as it is. Most chargemasters are created by multiplying acquisition cost or Medicare rates by some absurd number (typically 8-10) and calling it a day.
Frankly, I see this whole thing as a red herring. I get why people get upset about it, but if you ended this practice then the money would just shift somewhere else. Hospitals are mostly non-profits with small margins, so the money has to come from somewhere. Instead of charging 10 times cost for everything they would just dump it all into a generic fee. This kind of stuff isn't actually relevant to the core problem of why healthcare is so expensive in the US.
It's definitely not a scrooge mcduck caricature situation. Like I said, most hospitals are non-profits who post their financial statements online. You can probably go look at your local hospital's statements to see what kind of margins they're working with. There are exceptions, but I'd bet they're pretty low.
What if we had a service that would take your itemized bill and spit out the fair market prices. Then, you would tell the hospital/doctor/insurance that you would pay this price and nothing more.
If enough people did that, could it actually work?
Cheap hospital bill, cheap pharmacy bill, pain in the butt for my friends and relatives.
> Cathy Birker-Hake tripped over a hose in her Valley Village backyard not long ago, dislocated her shoulder and made a beeline for the emergency room.
Nobody’s hopping on a plane to India with a dislocated shoulder.
I would definitely fly somewhere for a planned surgery.
The cost for the shots was ~200$, and ~300$ for consultation, which was a PA giving me printouts about information of what diseases are found in which countries.
What a scam.
Personally not a fan of vaccines for multiple reasons, but I got a feeling at some places if you just wanted only what was required they’d try to convince or guilt you into getting the others. Maybe though if knowing you are going to go on a trip where you need it, get it elsewhere... say you go vacation in Europe, probably cheap enough to self pay even without being covered by their insurance. Plus the ingredients can vary by country too. I guess the one approved for Canada and the one approved for the US are different yellow fever wise.
Amazing care. Amazing team and happy healthy wife and baby
Total cost? $0
Yep we do it well
Lil 8mm screw in my leg. I got a bunch. $800 each. TLSO brace, $4,000. Literally a modified dirtbike chest and back plate.
The medical system is entirely broken. Ditto the insurance system.
And it doesn't help that the price is basically opaque and paid for by insurance, for a person who doesn't care about the price at that moment.
It's a ridiculous system.
And you're a captive audience; they don't allow you to bring in your own supply.
If I actually went through the trouble of formally writing one up, and spreading it far and wide on the winds, and could actually get a significant portion of the population serving it in instances of predatory policy/pricing, and refusing the product such that a meaningful impact was made on service provider's bottom line, I've often wondered whether or not an equilibrium could finally be established where businesses stopped looking at customers who don't complain as people not yet sufficiently fleeced.
Note well: Yes, hospitals also gouge you. I am not claiming otherwise.
The important part is being over-charged 900% over retail price, not the exact retailer you buy it from.
Also, it's a sling, not an anti-HIV drug. Hardly a "medical supply".
I see these high prices for what appear to be commodity items in a similar light. You are paying for a certain amount of comfort that the sling will just work. Amazon is not going to care if the sling, which might be a cheap knock-off, rips apart while you’re walking and unseats your unhealed bone.
But this is more of a criticism of Amazon than anything, as those things would be true for a drugstore as much as it would be for a hospital.
Sometimes its all just a paper facade over simple stuff we can easily do for ourselves with the smallest amount of courage and effort.
However for a lot of other things though are literally the same product, so it really isn't equivalent. If you are paying more for an individual (regular) Tylenol than you would have regularly paid for a box of them, it's hard to argue "value".