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I moved to the US about a year ago. Went to ER for the first time ~3 months ago. I was charged about $4000 for: - Cleaning a wound (with water/desinfectant).

• village-idiot 8y ago
  And the worst thing is that there’s no way to predict the cost. Even if you go to an ER that’s in network (good luck with that in an emergency), you might be assigned an out of network doctor and be charged out of network prices
  • taurath 8y ago
    Worse - you can get a bill in the mail later for some out of network doctor who looked at a chart without ever interacting with you, in addition to the hospitals charge.
    • xvf22 8y ago
      Yup, or a bill from an out of network doctor that consulted while you were under or generally unaware [0] [0] https://www.nytimes.com/2014/09/21/us/drive-by-doctoring-surprise-medical-bills.html https://www.nytimes.com/2014/09/21/us/drive-by-doctoring-sur...
    • maxerickson 8y ago
      My favorite is that the hospital will use the external consultation to charge more for the visit.
      • olliej 8y ago
        Recruitment fee for the out of network you didn’t ask for!
  • benmorris 8y ago
    We've had 2 children in the last 4 years and this concept was foreign to me. Our 2nd child we were billed for an out of network anesthesiologist at an in network hospital. Several thousand dollars in total, I called the insurance after reading online a bit about it. Eventually they said they would "resubmit" the claim for reconsideration. A few weeks later we got an EOB showing we didn't have to pay any of it. The whole experience we shocking to me, I can't imagine dealing with this sort of thing on a regular basis. Even worse is receiving bills from various providers up to a year later. How are these people still in business?
    • village-idiot 8y ago
      Regulatory capture.
    • redler 8y ago
      Anesthesiology is a particularly pathological case, so to speak. You don't choose your anesthesiologist; it's the medical equivalent of a (very important and highly-paid) back-office function. So you've chosen an in-network hospital and an in-network surgeon? Surprise! You may also discover, months later, that your chart was read, while you were sleeping, by an out-of-network physician on call. Surprise! The American system is literally (literally literally) unsustainable.
    • wonderwonder 8y ago
      How could they go out of business? Any time they need money they can just go through patient records and charge for anything they feel like with very little statute of limitations. Its a license to print money at the expense of those that can least afford it.
      • fma 8y ago
        Yep...I got an email last week for something for my daughter's birth...which 2 years ago. It was charged to an insurance I no longer have. I met deductible that year so everything was covered and it says I'm paying $0. They could lie about the some missing cost and I wouldn't know where to begin disputing it. If I don't successfully dispute it, it goes to collections and hurts my credit. Is my time worth disputing a $500 bill (it I had to pay it?). It's a lose lose situation.
• outworlder 8y ago
  I got an abdominal ultrassound, because some of my bloodwork was off and the doctor wanted to confirmed my liver was ok. Very routine. So I agreed. 15 minutes from the time I got to the reception desk to the time I was out of the door. 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.
  • apsec112 8y ago
    Goddamn, are you me? I have the exact same story. Minor blood test anomaly, liver ultrasound, 30 minutes, surprise $6,000 bill. Pretty sure it's the same hospital too.
    • outworlder 8y ago
      The only thing that would make it weirder is if the initial bloodwork happened to have been also ordered and checked by a doctor from your company's 'health center'.
  • kevingadd 8y ago
    This is basically the reason I have Kaiser and have stuck with them for over a decade. The quality of service is shaky sometimes, and there is doctor turnover, and sometimes I have to travel relatively far to see a specialist - but if a KP physician refers me for something, I get scheduled to see someone, then I get it done, and I pay a reasonable copay that I know about immediately. I've never had to haggle with insurance or been surprised with fees later, even for relatively complex surgeries.
    • 8y ago
• irrational 8y ago
  Not just ER. We went to urgent care with a bean stuck up my sons nose. The doctor spent about 30 seconds getting it out. We were in and out in 10 minutes or so. The bill was $2000.
  • wonderwonder 8y ago
    Should have planted that bean. Maybe it would have grown an entire stalk of $2,000 beans. 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.
    • thaumasiotes 8y ago
      > 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?
      • irrational 8y ago
        How would you shop around?
  • umvi 8y ago
    Is that what you had to pay out of pocket? With or without insurance?
    • irrational 8y ago
      Unfortunately we thought that urgent care clinic was in-network, but it wasn't. Insurance covered a little bit, but we were left with the majority of the bill. We complained about the high cost and asked for a discount to no avail.
• robertAngst 8y ago
  Medical is in bed with the government https://www.opensecrets.org/lobby/top.php?indexType=s 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.
  • corey_moncure 8y ago
    This is amazing. The list reads like a "who's who" of the most insufferable sectors of American life. I was surprised not to see auto manufacturers and agriculture in the top twenty, but medicine and telecom have definitely got them beat.
    • robertAngst 8y ago
      What makes auto bad?
      • corey_moncure 8y ago
        The same kind of regulatory capture dynamics occurring with telecom and medicine. In the case of auto, preventing startup competition by mandating the old and needless system of dealer middlemen.
• lucaslee 8y ago
  Urgent care or walk-in clinics will likely cost much less. If it's a simple wound, a CVS clinic will work too. Some urgent care clinics post wait time online so you can find out how to see a doctor the fastest way.
  • ceejayoz 8y ago
    > 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-send-you-a-big-bill-just-like-the-er/ https://khn.org/news/surprise-that-urgent-care-center-may-se...
• xienze 8y ago
  Part of it is because consumers are completely detached from the price aspect of medical care. Getting an estimate, shopping around? Forget it. It’s a black box. And, frankly, part of it is because hospitals can’t refuse care to anyone and if they can’t pay, someone else has to.
  • darkerside 8y ago
    It's crazy because the initial idea was, insurers would be more educated buyers and thus better able to negotiate with medical providers. As it turns out, with no skin in the game, they hardly seem to care to negotiate prices at all!
    • olliej 8y ago
      They do negotiate - the prices they’re charged are vastly less than what you would be as an individual. 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.
  • iwiririwo 8y ago
    That's what mandatory insurance is for. Everyone pays what they can, and gets what they need. Doesn't work perfectly, but allows me to go to a hospital anytime without being broke after. There's benefit for everybody, which is risk reduction. You actually blame poor people for going to the ER in case of emergency.
  • maxxxxx 8y ago
    "And, frankly, part of it is because hospitals can’t refuse care to anyone and if they can’t pay, someone else has to. " 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.
    • maxerickson 8y ago
      It's substantial but doesn't come anywhere near explaining prices. The PDF here has some numbers: https://www.aha.org/data-insights/2018-01-03-uncompensated-hospital-care-cost-fact-sheet-december-2017-update 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).
• pcurve 8y ago
  In Japan or Korea, that would've been $50-$100 tops without insurance. 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.
• csense 8y ago
  That's an easy one. - (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.