5 ms·

We still cannot get a price list of medical procedures in the US thanks to the antitrust exemption provided in McCarran-Ferguson Antitrust Act of 1945. I think

by tmaly 8y ago

We still cannot get a price list of medical procedures in the US thanks to the antitrust exemption provided in McCarran-Ferguson Antitrust Act of 1945. I think repealing this would be a good start. All other industries are required to provide price lists. My friend went to the ER recently for a sprained thumb. They wrapped it in some bandage and he got a bill for $14,000. His insurance is covering 80% but he is still on the hook for $2800 for a sprained thumb. Something is not right here.

throwaway5752 8y ago
Why did he go to the ER?
- donaldknuth123 8y ago
  Depending on where you live an ER might be the only place you can go for an urgent medical issue. Was he supposed to wait a month to see a GP or drive across the state to find an Urgent Care?
- will_brown 8y ago
  I think you are trying to make some point about wasting resource...but the ER is how accute injuries like this are generally treated. Sure there may be urgent care centers equipped for this, but that isn’t a guarantee and those often have more restrictive hours than an ER, especially acces to urgent care services like x-rays or mri/cat scans. Sure in hindsight it’s a sprained thumb, but likely because of pain thought to be broken or worse...requiring x-ray and being set by a trained professional or maybe even surgery. It is a thumb so it would be less than ideal to lose feeling or mobility or the thumb itself (say there was nerve or circulatory damage).
- torpfactory 8y ago
  Thumb injuries are actually treated very seriously (at least more seriously than you might think) by medical professionals because thumb injuries can have very high consequences for quality of life. You can live a totally normal life without an index finger but a missing or disabled thumb is a much more significant impact.
  - throwaway5752 8y ago
    I know. To elaborate (and reply indirectly to will_brown) I think it's impossible to say how egregious $14k is for billing without knowing how severe a sprain it is and how much they had to do to diagnose it. Maybe he walked out with a bandage, but maybe he got an x-ray or mri? And ERs are expensive because they have to handle anything from a MI, stroke, poisoning, massive trauma, or ID case. If you go to one, you have to pay for use of that very complex facility. Then you pay for diagnostics that they deem necessary. Then you pay for the attending/specialist(s)'s time. A thumb trauma could be super severe and it was probably a good call, and it's great he walked out with a bandage. But I don't think that a $14K er bill is that out of bounds given what they are intended for, nor do I think that a bill needs to be commensurate with treatment rendered. edit: since this thread is about cancer, I will not reply more because it's OT in pretty fundamental ways. The US healthcare system has massive issues, but I am not sure this particular case relates to the thread or is a great example of the dysfunction in general. A price sheet is not possible for "my thumb really hurts" ... it will depend on a lot of situationally appropriate decisions being made by the attending that cannot be predicted.
    - madeofpalk 8y ago
      > I think it's impossible to say how egregious $14k is I live (well, lived. currently in the UK) in Australia, and the concept of a $14k bill for a sprained thumb is so out of my world. I cannot fathom how anyone would find that even remotely acceptable.
      - sbov 8y ago
        In the USA, what a hospital charges does not necessarily have any correlation with the cost of servicing your problem. In the same city, the price of a procedure from hospital to hospital can vary by up to 10x.
      - billforsternz 8y ago
        On the weekend my 83 year old mother in law fell and broke her ankle. One hour ambulance ride to a metropolitan ER. Examination and diagnosis by a trauma specialist and an orthopedist. X-ray. Moonboot applied, a night in hospital as community team were assigned to make her adjustments to her apartment for recovery period. Physiotherapist consultation and ongoing support. No insurance. Total cost zero dollars. In New Zealand and proud at times like this.
sbov 8y ago
Don't go to the ER for a sprained thumb. Unless its an actual emergency, go to urgent care. I live in a pretty expensive area of California and they still only charge $95 per person they see. And our insurance covers it completely. And rightly so, they would much prefer a $95 bill to a $14,000 one. With kids we go a couple times per year. They definitely have saved us a lot of money and time.
- thebooktocome 8y ago
  Urgent care doesn't exist in some jurisdictions.
- germinalphrase 8y ago
  Urgent care also closest. My closes urgent care is open from 8 am - 6 on. The rest close by 8. Deep cut at 9pm... emergency room is only option.
- rtkwe 8y ago
  As other have said urgent care isn't everywhere and closes so it's not entirely by choice that people wind up in the emergency room for non emergency things. Beyond that it's hard to know sometimes what's emergency and what isn't until you have a doctor look at what's happening.
  - ams6110 8y ago
    OK but a sprained thumb is not something that can't wait until morning. Take a couple of Advil and put some ice on it.
    - Cd00d 8y ago
      That assumes the patient _knows_ it's only a sprain.
      - malyk 8y ago
        It's likely the same for any break that is in the "not sure if is sprain or break" range. Years ago I crashed my mountain bike and had a high suspicion that I had broken one of my fingers. Urgent care was closed by the time I got home and cleaned up and my college roommate was in town so I met up with him after taping my fingers together to prevent unnecessary/unplanned movement. Urgent care confirmed a break the next morning, and fixed everything for $300. Healed perfectly. Anyway, anecdotes are just that, but the emergency room is not the place to go for "simple" things like a possible sprain, minor break.
kindatrue 8y ago
Interesting trivia - health insurers kind of don't care about these big bills, despite what most people think: https://www.propublica.org/article/why-your-health-insurer-does-not-care-about-your-big-bills https://www.propublica.org/article/why-your-health-insurer-d...
- clairity 8y ago
  not sure it's trivia. it's pretty straightforward though: higher bills means more money insurance companies can skim off the top without patients objecting. direct costs are basically pass-throughs to policy holders. the risks are higher but execs are in it for salaries and bonuses, so that exhibits the principle agent problem.
ticviking 8y ago
This! I've got family in health management and THEY can't reliably figure out what a procedure costs(not even something like a simple statistical characterization) much less what they should charge for it.
jimmydddd 8y ago
Yes-- we need price information. A family member (US citizen) lives in Europe and has free government health care there, but you often have to wait several months to get treated. Instead of waiting, she thought she might just do needed cataract surgery in the US to get it done if it didn't cost too much. I called several medical centers that do cataract surgery for an estimate. Can't provide it. Can you give a ballpark range? No. Can you say if it's closer to $1k, $10k or $100k? No.
- dagw 8y ago
  Instead of waiting, she thought she might just do needed cataract surgery in the US Just about every country in Europe has private hospitals that will do non-emergency surgeries without wait if you pay. They'll also have no problem quoting you a fairly exact cost if you call them up.
  - vsl 8y ago
    Not universally true. I can't get better care even if I pay for it, I'm only legally allowed to pay only for trivia; the only care available to me is the "free" (read: costing ~8% of my income in mandatory medical tax) one with, yes, months of waiting and nobody giving a damn about you. It's almost certainly better than the US system, but it's not all roses in EU either.
    - dagw 8y ago
      I don't know where you are, but if nothing else there is nothing stopping you from getting on the next plane/train to Germany or wherever and having the operation done there.
joelx 8y ago
Our healthcare system is set up for the enrichment of doctors at the expense of patients. Here is a great article showing this yet again. When you go get a fast food hamburger for $1.49, you will only extremely rarely receive a poorly made burger or have a billing mistake or get food poisoning. So why are you virtually guaranteed to not get what you pay for and get overbilled anytime you visit a hospital? The doctors union has strictly prevented any kind of competition and innovation in healthcare.

by tmaly 8y ago

throwaway5752 8y ago

Why did he go to the ER?

donaldknuth123 8y ago
Depending on where you live an ER might be the only place you can go for an urgent medical issue. Was he supposed to wait a month to see a GP or drive across the state to find an Urgent Care?
will_brown 8y ago
I think you are trying to make some point about wasting resource...but the ER is how accute injuries like this are generally treated. Sure there may be urgent care centers equipped for this, but that isn’t a guarantee and those often have more restrictive hours than an ER, especially acces to urgent care services like x-rays or mri/cat scans. Sure in hindsight it’s a sprained thumb, but likely because of pain thought to be broken or worse...requiring x-ray and being set by a trained professional or maybe even surgery. It is a thumb so it would be less than ideal to lose feeling or mobility or the thumb itself (say there was nerve or circulatory damage).
torpfactory 8y ago
Thumb injuries are actually treated very seriously (at least more seriously than you might think) by medical professionals because thumb injuries can have very high consequences for quality of life. You can live a totally normal life without an index finger but a missing or disabled thumb is a much more significant impact.
- throwaway5752 8y ago
  I know. To elaborate (and reply indirectly to will_brown) I think it's impossible to say how egregious $14k is for billing without knowing how severe a sprain it is and how much they had to do to diagnose it. Maybe he walked out with a bandage, but maybe he got an x-ray or mri? And ERs are expensive because they have to handle anything from a MI, stroke, poisoning, massive trauma, or ID case. If you go to one, you have to pay for use of that very complex facility. Then you pay for diagnostics that they deem necessary. Then you pay for the attending/specialist(s)'s time. A thumb trauma could be super severe and it was probably a good call, and it's great he walked out with a bandage. But I don't think that a $14K er bill is that out of bounds given what they are intended for, nor do I think that a bill needs to be commensurate with treatment rendered. edit: since this thread is about cancer, I will not reply more because it's OT in pretty fundamental ways. The US healthcare system has massive issues, but I am not sure this particular case relates to the thread or is a great example of the dysfunction in general. A price sheet is not possible for "my thumb really hurts" ... it will depend on a lot of situationally appropriate decisions being made by the attending that cannot be predicted.
  - madeofpalk 8y ago
    > I think it's impossible to say how egregious $14k is I live (well, lived. currently in the UK) in Australia, and the concept of a $14k bill for a sprained thumb is so out of my world. I cannot fathom how anyone would find that even remotely acceptable.
    - sbov 8y ago
      In the USA, what a hospital charges does not necessarily have any correlation with the cost of servicing your problem. In the same city, the price of a procedure from hospital to hospital can vary by up to 10x.
    - billforsternz 8y ago
      On the weekend my 83 year old mother in law fell and broke her ankle. One hour ambulance ride to a metropolitan ER. Examination and diagnosis by a trauma specialist and an orthopedist. X-ray. Moonboot applied, a night in hospital as community team were assigned to make her adjustments to her apartment for recovery period. Physiotherapist consultation and ongoing support. No insurance. Total cost zero dollars. In New Zealand and proud at times like this.

sbov 8y ago

Don't go to the ER for a sprained thumb. Unless its an actual emergency, go to urgent care. I live in a pretty expensive area of California and they still only charge $95 per person they see. And our insurance covers it completely. And rightly so, they would much prefer a $95 bill to a $14,000 one. With kids we go a couple times per year. They definitely have saved us a lot of money and time.

thebooktocome 8y ago
Urgent care doesn't exist in some jurisdictions.
germinalphrase 8y ago
Urgent care also closest. My closes urgent care is open from 8 am - 6 on. The rest close by 8. Deep cut at 9pm... emergency room is only option.
rtkwe 8y ago
As other have said urgent care isn't everywhere and closes so it's not entirely by choice that people wind up in the emergency room for non emergency things. Beyond that it's hard to know sometimes what's emergency and what isn't until you have a doctor look at what's happening.
- ams6110 8y ago
  OK but a sprained thumb is not something that can't wait until morning. Take a couple of Advil and put some ice on it.
  - Cd00d 8y ago
    That assumes the patient _knows_ it's only a sprain.
    - malyk 8y ago
      It's likely the same for any break that is in the "not sure if is sprain or break" range. Years ago I crashed my mountain bike and had a high suspicion that I had broken one of my fingers. Urgent care was closed by the time I got home and cleaned up and my college roommate was in town so I met up with him after taping my fingers together to prevent unnecessary/unplanned movement. Urgent care confirmed a break the next morning, and fixed everything for $300. Healed perfectly. Anyway, anecdotes are just that, but the emergency room is not the place to go for "simple" things like a possible sprain, minor break.

kindatrue 8y ago

Interesting trivia - health insurers kind of don't care about these big bills, despite what most people think: https://www.propublica.org/article/why-your-health-insurer-does-not-care-about-your-big-bills https://www.propublica.org/article/why-your-health-insurer-d...

clairity 8y ago
not sure it's trivia. it's pretty straightforward though: higher bills means more money insurance companies can skim off the top without patients objecting. direct costs are basically pass-throughs to policy holders. the risks are higher but execs are in it for salaries and bonuses, so that exhibits the principle agent problem.

ticviking 8y ago

This! I've got family in health management and THEY can't reliably figure out what a procedure costs(not even something like a simple statistical characterization) much less what they should charge for it.

jimmydddd 8y ago

Yes-- we need price information. A family member (US citizen) lives in Europe and has free government health care there, but you often have to wait several months to get treated. Instead of waiting, she thought she might just do needed cataract surgery in the US to get it done if it didn't cost too much. I called several medical centers that do cataract surgery for an estimate. Can't provide it. Can you give a ballpark range? No. Can you say if it's closer to $1k, $10k or $100k? No.

dagw 8y ago
Instead of waiting, she thought she might just do needed cataract surgery in the US Just about every country in Europe has private hospitals that will do non-emergency surgeries without wait if you pay. They'll also have no problem quoting you a fairly exact cost if you call them up.
- vsl 8y ago
  Not universally true. I can't get better care even if I pay for it, I'm only legally allowed to pay only for trivia; the only care available to me is the "free" (read: costing ~8% of my income in mandatory medical tax) one with, yes, months of waiting and nobody giving a damn about you. It's almost certainly better than the US system, but it's not all roses in EU either.
  - dagw 8y ago
    I don't know where you are, but if nothing else there is nothing stopping you from getting on the next plane/train to Germany or wherever and having the operation done there.

joelx 8y ago

Our healthcare system is set up for the enrichment of doctors at the expense of patients. Here is a great article showing this yet again. When you go get a fast food hamburger for $1.49, you will only extremely rarely receive a poorly made burger or have a billing mistake or get food poisoning. So why are you virtually guaranteed to not get what you pay for and get overbilled anytime you visit a hospital? The doctors union has strictly prevented any kind of competition and innovation in healthcare.