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I took my 4 year old to the ER because he had a 103 fever. The doctor put an ear thermometer to him and told me to give him some childrens ibuprofen. The visit

I took my 4 year old to the ER because he had a 103 fever. The doctor put an ear thermometer to him and told me to give him some childrens ibuprofen. The visit lasted all of 5 minutes. The cost: $756.00. I refused to pay it. It was the first time I did not pay a debt and the first time I was sent to collections. I refused based on principle, and not because I couldn’t afford it. Collections called me for about 3 months, and every time someone called and said, “is this John Wheeler”, I would never confirm and then go about asking why they are calling for John Wheeler. Eventually, the calls stopped and the collection agency wrote it off to their unpaid reserves (I’m assuming), I never received a ding on my credit report. Everyone is always asking why US healthcare is so expensive. People blame it on the insurance companies and the hospitals, but my theory is it’s the providers. I worked at Vanderbilt on their payroll system, and I would regularly see general practitioners making $350,000 a year, and this was 15 years ago! It wasn’t uncommon to see teaching doctors getting paid a million dollars.

Aloha 7y ago
Wait till they sue you, I successfully fought off an almost 4 year old sub $2000 medical debt when I was sued for it.
point78 7y ago
Well as screwed up as the system is one little part of why prices are so high is to cover when people don't pay.
- johnwheeler 7y ago
  Well then it sounds like a vicious circle. Should we fix it by paying exorbitant fees or charging reasonable prices?
  - doctorpangloss 7y ago
    People saying, 'We should pay for the things I do in the economy, but not something someone else does, "out of principle"' is an opinion that exists in reality, it's just an unbecoming and non-constructive one.
    - johnwheeler 7y ago
      Is it more, or less unbecoming than charging $756.00 to take someone’s temperature?
- alexpetralia 7y ago
  If people did pay, would hospitals lower their prices? Is the market that competitive? If not, where would the extra money go?
- neya 7y ago
  Then how do you explain countries like India where it's drastically affordable and high quality at the same time?
  - seanmcdirmid 7y ago
    You pay at the entrance, not at the exit. Also, standards of care, facility costs, and compensation for medical professionals is much lower.
    - techie128 7y ago
      I am sure you have data to back up your claim that "standards of care, facility costs, and compensation for medical professionals is much lower." Care to post it?
      - seanmcdirmid 7y ago
        I’ve only been in the hospital in India once (food poisoning), but everything was vastly different from the states. It was pretty cheap, and I had to pay up front. Fairly sure Indian doctors make much less than American ones, because I don’t have the empirical evidence of that that you are looking for.
    - thatfrenchguy 7y ago
      Idk, doctors in France are literally 10x cheaper and the standard of care is actually higher. The US has a big cost control issue even for your PCP.
    - neya 7y ago
      This is simply not true enough to be generalized. In most hospitals always pay at the exit unless you weren't there for some pre defined checkup package instead of proper consulting.
  - rayiner 7y ago
    You can’t compare the costs of labor-intensive services across countries with dramatically different labor costs. When we lived in Bangladesh, my dad made maybe $40,000/year (in today’s money). My mom stayed home and we had a full time live in cook, nanny, and housekeeper.
- gwbas1c 7y ago
  Not true at all. The reason why prices are so high is because of the complicated billing system that each insurance provider has. Medical providers have to create positions just for people to bill insurance. It's gotten to the point where single-payer health care will be cheaper just because of the paperwork it'll save. (Not that I personally advocate for single-payer. We can also lower costs by correctly regulating private insurance.) By the way, if you're into economics, look into Adam Smith's Wealth of Nations. Kings used to do the same things to keep peasants busy while they profited. This is no different.
  - refurb 7y ago
    Medical providers have to create positions just for people to bill insurance It's the same in Canada. Billing doesn't go away under single payer. Sure it's likely less complex, but someone still needs to do it.
avocado4 7y ago
https://www.politico.com/agenda/story/2017/10/25/doctors-salaries-pay-disparities-000557 https://www.politico.com/agenda/story/2017/10/25/doctors-sal... Providers are the core problem. Various doctor associations (AMA et al) have strangled supply side of healthcare through State licensure and scope of practice laws. Just read medical forums to get an idea of what an average doctor thinks about competition in the form of midlevels: https://www.auntminnie.com/Forum/tm.aspx?m=581583 https://www.auntminnie.com/Forum/tm.aspx?m=581583 "Don’t teach your mid levels procedures... Ultimately, a mid level that can do procedures, even easy ones, are your competitors." https://www.auntminnie.com/forum/tm.aspx?m=581130 https://www.auntminnie.com/forum/tm.aspx?m=581130 It's not politically talked about because it's much easier to blame corporations than your neighborhood doctors. There's enough leeches downstream too (insurance, pharma, PBMs, administrators, etc) but gatekeeping at the supply side is what's making it possible.
- evrydayhustling 7y ago
  That forum is amazing! Thanks for the primary source! That said, two quibbles/questions: Those same threads have logins like "indebt4life" and "kids2feed", which matches what I've heard from doctor friends: the length and cost of medical training and insurance are so brutal that the folks gatekeeping are themselves in an unhealthy lifestyle and don't want it to get worse. In other words, and benefits of gatekeeping accrue to the school and hospital complex more than the individual practirioners. Separately, what's the breakdown of specialist labor costs vs drugs and equipment? My experience has been that the crazy bills are for stuff , not people.
  - jopsen 7y ago
    > My experience has been that the crazy bills are for stuff , not people. That could just be an accounting trick, since you're more willing to pay for stuff than people. (On topic: obviously, there's many reasons for costs, doctors isn't the only one)
  - AnthonyMouse 7y ago
    > Those same threads have logins like "indebt4life" and "kids2feed", which matches what I've heard from doctor friends: the length and cost of medical training and insurance are so brutal that the folks gatekeeping are themselves in an unhealthy lifestyle and don't want it to get worse. It's gatekeeping that causes that. There are complex procedures that require a decade of medical training and simpler ones that don't. If you take the doctor with the extensive training and have them do only the complex procedures, it's easy to justify paying them mid six figure salaries that cover their costs. But if you have regulations that require that same doctor to spend three quarters of their time doing simple procedures that could reasonably be done by a PA or a nurse, the average value of their services drops and they have a harder time commanding a salary that can pay for their schooling and insurance.
ssx 7y ago
If you had insurance it wouldn’t have been so high. If you don’t have insurance, you literally are the problem.
- johnwheeler 7y ago
  I do have insurance. That was my deductible.
  - mehrdadn 7y ago
    Did your insurance go up after the fact?
- velcrovan 7y ago
  > If you had insurance it wouldn’t have been so high. Not true, most people's deductibles are more than what they charged him.
- nonbel 7y ago
  No, the people who keep paying insurance companies to inflate prices to insane levels are the problem.
Shivetya 7y ago
if you are upset over their pay imagine how you must feel about those in public service, let alone their pensions. you can pull down those numbers being a city manager and get over 100k in pension to boot! the medical profession is not easy and i don't begrudge them their fees.
- deleted 7y ago
  [deleted]
- ceejayoz 7y ago
  > you can pull down those numbers being a city manager Where? NYC's mayor doesn't even make those numbers.
  - roywiggins 7y ago
    There are NYC employees making 350k salaries. https://data.cityofnewyork.us/City-Government/Citywide-Payroll-Data-Fiscal-Year-/k397-673e https://data.cityofnewyork.us/City-Government/Citywide-Payro...
    - ceejayoz 7y ago
      The three making $350k are the folks running the pension funds, a job that'd be easily earning them a million plus on Wall Street. The public sector's pensions have always been a bit of compensation for the sub-market salaries. This bears that out.
mehrdadn 7y ago
> I refused to pay it. It was the first time I did not pay a debt and the first time I was sent to collections. I refused based on principle, and not because I couldn’t afford it. Why not at least pay a portion of it that you would have felt was sensible?
- wikibob 7y ago
  By paying even $0.01 you acknowledge the validity of the debt and then it’s much easier for them to sue you and get a judgement.
  - mehrdadn 7y ago
    Wait really? How so? It's not like they would otherwise lack sufficient evidence to show you showed up and received care, right? I would've thought acknowledging would just restart the clock, which would've made no difference here.
    - xemdetia 7y ago
      It's the same logic as refusing delivery of a shipped good when it comes to contract law (IANAL). It's expected that when a good arrives, the buyer pays. If the buyer refuses to pay then the good is not 'delivered.' In the transition to services the 'delivery' is the invoice you get and that is the moment you are compelled as the buyer to pay that invoice. If you start paying it then you have accepted the invoice as valid because you paid for part of that invoice. Given this the context of being sued would be that the seller observed that the invoice was valid by the buyer paying something towards that invoice, and therefore they should be compelled to pay the rest of the invoice. On the other hand if an invoice is never realized because it's in dispute, then you have a stronger leg to stand on. A different way to look at is in sit-down dining. You receive service, you are delivered a bill, you are then expected at the moment the bill is delivered to review it and pay it, and if you pay it the bill is settled. If you have a dispute because nobody ordered a diet coke, then the bill is rejected and hopefully sorted out before a final bill is presented and people pay for it. The same sort of logic ends up applying here. If you paid for half the meal and left that has different outcomes compared to not paying the bill and causing a stink.
krooj 7y ago
One really nice thing about single-payer back in Ontario was public salary disclosure, aka, the sunshine list. Since most physicians essentially work for the government, if they make over 100k/yr, the salary is public knowledge. Hint: Canadian doctors aren't eating dirt, by any means.
- refurb 7y ago
  Most Canadian doctors don’t work for the government if they have their own practice, which is the most common. I guess if they worked for a public hospital they would, but that’s not all doctors.
skadamou 7y ago
Those numbers do seem to be a bit higher than the national salary averages for physicians [1]. However, physician pay only amounts to something like 8% of total health care costs [2]. I'm not saying that doctor pay at Vanderbilt isn't driving up their healthcare costs but this doesn't seem to be the whole story when it comes to national healthcare costs. [1] https://www.merritthawkins.com/news-and-insights/blog/job-search-advice/physician-starting-salaries-by-specialty-2018-vs-2017/ https://www.merritthawkins.com/news-and-insights/blog/job-se... [2] https://jacksonhealthcare.com/media-room/news/md-salaries-as-percent-of-costs/ https://jacksonhealthcare.com/media-room/news/md-salaries-as...
- wisty 7y ago
  The structure is a messed up mix of the red tape and regulation of a government bureaucracy, monopolistic behaviour (try getting 3 quotes for a procedure like you would for a bathroom renovation), subsidies, freeloaders, and weird incentives. The government has decided it's too stupid to run hospitals. But it's also decided that it needs to ensure both the supply of hospitals, and to maintain standards. So instead of just telling doctors what to do (and paying them enough to ensure a steady stream of high quality medical students) it tries to get all the red tape and subsidies right, while the private sector (hospitals and insurers) try to figure out how to outsmart the government and make the system more expensive. The US government spends a similar amount (per captia or as a percent of GDP) as Canada on its public funding (Medicare, Medicaid, VA, and so on). But the US system is so fantastically inefficient (due to weird incentives and massive amounts of bureaucracy and profit seeking) that unlike Canada it can't even offer basic universal healthcare (despite spending an insane amount of tax dollars).
  - dragonwriter 7y ago
    > The US government spends a similar amount (per captia or as a percent of GDP) as Canada on its public funding (Medicare, Medicaid, VA, and so on). As of 2016, Canada's public spending was 7.4% of GDP, the US's was 8.5%; and the US per-capita GDP is higher, too, so I don;t think its really "a similar amount" per capita, and only loosely so per GDP. But, yeah, the big difference is that the US spends even more than the publicly spending in private healthcare spending, while Canada (like most other first-world countries) spends far less privately than the public share. https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/#item-u-s-similar-public-spending-private-sector-spending-triple-comparable-countries https://www.healthsystemtracker.org/chart-collection/health-...
cwilkes 7y ago
If it was so easy to diagnose then why didn’t you do it yourself? What you are paying for is piece of mind and expert advice. What would you do if someone wanted your expert advice on something you told them your fee and then solved their problem in 5 minutes and they balked at paying you? This is the old saw about $1 for the work and $999 to know where to hit the machine with a hammer.
- johnwheeler 7y ago
  OK, following your logic, when is too much, too much? Remember that prices are not disclosed before treatment. Would a million dollar bill be reasonable?
- Retra 7y ago
  If they knew the costs before being charged, you could make a stronger argument. As it is, they are not being charged for expertise, but for being ignorant of the costs.
- markdown 7y ago
  > $1 for the work and $999 to know where to hit the machine with a hammer. In your example, $999 would be fair, but they're charging $9999.
dshep 7y ago
I recently took my GF to the ER because she had been stung by a bee and was worried she was allergic. She was feeling dizzy but once we were in the ER she started feeling better. They basically took her vitals, waited 30 minutes or so, gave her a steroid, and then sent us home. They told us it probably wouldn't be very expensive as she was uninsured. Later the bills arrived: $1300 from the ER ($1900 minus a $600 uninsured discount) and $600 from the PA who saw us. Insane!
- Spooky23 7y ago
  Generally speaking, that’s an example of a fundamentally wasteful ER visit, and why the lack of universal coverage is so dumb. That’s why ERs cost a fortune. If you’re not bleeding, have a broken limb or other trauma or an expectation of being admitted, you don’t belong in the ER. Take a benadryl.
  - Nextgrid 7y ago
    The ER is more like insurance. In this case she was fine and got better more or less on her own but what if she deteriorated quickly? The ER would have the appropriate skill and equipment in-house to save her, whether if she was at home it might’ve been too late to make it to the ER when things actually became critical.
    - khuey 7y ago
      Reminds me of this: https://www.vox.com/health-care/2019/5/10/18526696/health-care-costs-er-emergency-room https://www.vox.com/health-care/2019/5/10/18526696/health-ca... "Clark had to decide: Should she take Lily to the emergency room? She called a poison control hotline and the answer was yes ... But Clark knew that the emergency room can be expensive. ... “I’m weighing my options,” Clark says. “She could have a seizure at any moment. It felt terrible, as a parent, to be in the position of having to do that.” Clark and her husband decided to give Lily some activated charcoal at home and drive to the emergency room. But they wouldn’t go inside. Instead, they pulled their car into the second row of the parking lot, about 100 feet from the entrance. They start playing The Little Mermaid on the car’s TV screen for Lily to watch. And they waited. “We were just sitting there, facing the door and watching Lily,” Clark says. “We chose the second row because we wanted to be close to the entrance, but also trying to look inconspicuous.” The Clarks waited in the parking lot for a few hours, and Lily didn’t show any symptoms. They drove home without setting foot in the emergency room."
rlpb 7y ago
I have read elsewhere, but cannot find a reference right now, that insurers typically pay only a percentage of any bill and expect the provider to accept it in final settlement. The percentage gets negotiated around. If this is true, then it makes sense that the providers inflate their original bills so that when they get the proportional settlement, the amount they receive is reasonable. The claim was that individuals settling directly are merely caught in the crossfire. If this is true, then it's not the providers being unreasonable.
- nonbel 7y ago
  https://en.wikipedia.org/wiki/Chargemaster https://en.wikipedia.org/wiki/Chargemaster
- refurb 7y ago
  There a few different drivers of the ridiculous list prices at hospitals. 1. The gov't forces them to disclose a price and they can't charge higher than it. Thus, they have every incentive to make it really high, then give preferred customers (insurers) a discount. 2. The system is firmly locked into a cycle of "percent of charges". Basically the insurer says "I know your chargermaster prices are inflated, so let's agree on 20% of that". The following year the hospital jacks up the chargemaster prices during negotiation so they start from a higher initial point.
  - deleted 7y ago
    [deleted]
OrgNet 7y ago
with my insurance, it cost you about the same for healthcare whether you are insured or not... (not including the insurance costs or government fines for lack of insurance)... mainly because they give a discount to the uninsured....
- PorterDuff 7y ago
  Dunno if that's strictly true. A story. Emergency room visit for moi (super high BP plus PVC that appeared out of nowhere). They hook up an EKG machine, wait an hour, tell me to see my doctor. Since it was a heart thing, I got bumped to the head of the line but forget to fork over my insurance card. Bill #1 $10k from hospital $2.5k from ER physician Bill #2 $4k if I pay it right away in cash Bill #3 $500 (deductible cost) once the insurance people are brought into the picture.
Balgair 7y ago
I have a similar story about vaccinations in grad school, religious waivers, and a racket that the medical school's insurance was running here: https://news.ycombinator.com/item?id=19760317 https://news.ycombinator.com/item?id=19760317 TLDR: Single payer, yesterday!
- mehrdadn 7y ago
  Wow. There's just too much irony in a medical school telling students to use religious vaccination exemptions because the insurance they provide doesn't cover their mandated vaccinations.
alexhutcheson 7y ago
ER bills are always shockingly expensive. If you don't think your condition is life-threatening, it's normally both faster and much cheaper to go to an urgent care clinic if one is open. However, for potentially very serious problems (possible heart attack, stroke, serious injuries, etc.) you have no choice - you need to go to the ER and deal with the bill afterwards.
- kickopotomus 7y ago
  > 4 year old to the ER because he had a 103 fever I think most parents would react similarly. Then to turn around and bill $756 is predatory.
  - alexhutcheson 7y ago
    Yeah didn’t mean to criticize anyone’s behavior, just offering a tip for people in that situation in the future. A child with a high fever is probably going to get seen faster at urgent care, since the ER staff would triage them behind serious injuries, heart issues, etc.
teej 7y ago
> The doctor put an ear thermometer to him and told me to give him some childrens ibuprofen. To be fair, the doctor also cleared your child of having a life threatening emergency. That is one of the critical jobs of an emergency medicine physician and it’s part of what you pay for.
tandem_bike 7y ago
Everything you say is true. Modern healthcare is so expensive and inefficient because its built around the demands and capabilities of the past. Usually I hate it when people say something is fundamentally broken, but healthcare really is. The time has come for a complete overhaul of the system. No more primary care doctors. They can be replaced by software and patient service representatives. Diagnostic services should be the front line of healthcare. You should be able to get whatever diagnostic test you want, whenever you want. All prices must be 100% transparent to the patient before any services are rendered. Opaque pricing allows for arbitrarily high pricing. Huge increases in medical school enrollments. Removal of arbitrary licensing caps. So much more needs to be done but this is a start.
- tasty_freeze 7y ago
  > You should be able to get whatever diagnostic test you want, whenever you want. Tests may be less expensive than what we are getting billed, but they aren't free. There are hypochondriacs who I'm sure would order hundreds of tests a year if allowed. There are many people who have hard to diagnose problems, and out of desperation, would order tests which have no possible bearing on their condition, just in case it finds something. Let's say that you routinely screen everyone for everything, because why not, it's free. What is the burden of not only performing all those tests, but following up on the flood of false positives? It would probably swamp the healthcare system, allocating resources to the wrong places.
- jimmaswell 7y ago
  Unlimited licensing could lead to everyone getting paid too low or unemployment. I've honestly wondered if compsci is goingto need caps. Everywhere is unreasonably picky about who will be considered even for an internship, because they can, because there are so many compsci grads. Getting my first job involved months of searching and horrible offers like 30k until I got lucky. This being with extensive volunteer experience since high school, 3.8 college gpa, honors in a tech school my high school sent me to, and an internship. I've seen lots of horror stories of CS grads applying everywhere for years fruitlessly because nobody wants them. Is this what we want to happen to doctors?
Spooky23 7y ago
Most offensive to me is that a nurse practitioner seeing you may result in the same bill, although she makes $100k.
arbuge 7y ago
> Everyone is always asking why US healthcare is so expensive. People blame it on the insurance companies and the hospitals, but my theory is it’s the providers. I worked at Vanderbilt on their payroll system, and I would regularly see general practitioners making $350,000 a year, and this was 15 years ago! It wasn’t uncommon to see teaching doctors getting paid a million dollars. I agree it's the providers which are most at fault. Hospitals (as well as drug companies) are providers too though not just doctors. It's hospitals that are charging $4,000 a night for a hospital room and $50 for 2 tylenol which you can pick up at Walgreens for $4 for a 24-pack. Actual examples from my hospital bill when I had my appendix removed a few years ago. The total came to about $50k, of which I believe the portion that went to doctors and surgeons was about $10-15k.
abraae 7y ago
Here's a contrasting story. On holiday in Rarotonga, our 2 year old got a chest infection. We made it way up the hill to the hospital. A stray dog watched from the side of the road as we drive into the parking area. No one in sight. Eventually we saw someone who pointed us to a building wherein sat the duty doctor. Super efficient, trained in new Zealand, she examined the sprog, diagnosed him and gave us the appropriate meds. No waiting, all sorted in less than 20 minutes. Finally she said apologetically that we would have to pay - $2.50. She took the money and out it into an old fashioned money box and cheerily sent us on our way.
- zanny 7y ago
  To be fair that isn't the whole story and doesn't really make for a convincing argument to the contrary. Doctors should be paid well, and in the case of the Cook Islands I assume they have public institutions providing doctors and medicine. In which case, tax payers are paying for it. Which is almost always the most ethical way to do it, and the only really right way we have working practicably in the world today, but it isn't some impossible efficiency that $2.50 supports the costs of operating the hospital, the cost of the drugs, training the doctor, and paying them a wage to justify their skill and expertise required. Its largely where many politicians in the US arguing for fundamental change to the system come from - its really hard to imagine anything much worse than what they US has now. It would actually take considerable effort to design a more inefficient, more obfuscated and incomprehensible, more exploitative and harmful way to organize medicine professionally. People just don't want to acknowledge that the United States federal government is not acting on the behalf of its citizens in its decisions whatsoever. It hasn't for decades, but coming to terms with the dissolution of democracy and the reality that US citizens don't have a meaningful, statistical say in government anymore is a hard pill to swallow, because the answers to the question "what do we do about it, then?" are all ugly.
  - abraae 7y ago
    It wasn't meant to be a convincing argument to the contrary - merely a contrasting story. And certainly if I had a rare cancer I would rather be in the Mayo Clinic, as long as my insurance was all lined up. Certainly these are difficult problems to grapple with, and bewildering to people outside the US - the current situation and also the extreme proposals currently being touted.
programmertote 7y ago
Finally, someone said this. It's very rare to see putting some blame on doctors for such exorbitant medical prices in the US. I have made several comments about that on HN describing similar observation that I found. A recent example was when I went to see a doctor for ear infection. She put a otoscope in my ear, looked at it for one minute, prescribed me some anti-bacterial, and wrote up $250 for the service. The first time I came to the US, the same thing happened (I have had ear infection occasionally). I went to a hospital in NJ because my host family at the time drove me there. I didn't have insurance and they sent me to the ER department. I was charged $500. In the US, the journey to become a doctor is made unnecessarily complicated and once people become doctors, they do gatekeeping and make sure it's equally as hard for others to become one. But the reality is that the physicians who treat garden-variety diseases can be trained much less expensively. No wonder physicians make loads of money while complaining about their massive student loan. My gf is a medical resident; my host parents in the US are both doctors; I have so many doctors as acquaintances; and I know that what they do is NOT even remotely difficult in terms of intellectual demand (only physically tiring and emotionally draining sometimes when you have to deal with difficult patients). I, as a programmer, would switch my salary with them in a heartbeat (regret leaving medical school in after second year in my home country, though I hated it at that time because of the sheer amount of rote memorization one had to do) and I do believe what I do everyday requires at least equally tasking mental load than what doctors do.
- caraffle 7y ago
  There's a lot wrong with the medical field, but this is a ridiculous argument. Programming is hard, medicine is hard. But it's in different ways - it's definitely not transposable (obviously- you switched the other way). I say that as someone who worked in FAANG software and is now in medicine. Equating salary to mental load is also factitious. Manual laborers work harder than all of us, maybe we should switch salaries with them. I 100% agree with the difficulty of becoming a doctor. I disagree with the gatekeeping however. Ultimately it comes down to residency positions available, and funding is government limited. We're seeing tons of new medical schools opening, acceptance of the DO crowd, and still the system is getting more competitive.
cosmie 7y ago
> I never received a ding on my credit report. Non-medical and medical collections tend to get different treatment nowadays[1][2]. It may have ended up on your credit but after a super long delay, or it'd disappear entirely if they were able to get something out of your insurance instead. And even if it shows up on your credit report, depending on the specific scoring model being used, it still may not have had much if any impact. [2] details how some of the scoring models treat medical collections. [1] https://www.experian.com/blogs/ask-experian/can-medical-bills-affect-credit-report/ https://www.experian.com/blogs/ask-experian/can-medical-bill... [2] https://www.creditkarma.com/advice/i/how-to-remove-medical-collections-from-credit-reports/ https://www.creditkarma.com/advice/i/how-to-remove-medical-c...
- np_tedious 7y ago
  Is there any potential for an incident like this without a loan agreement to impact credit history / score?
  - cosmie 7y ago
    Technically, anyone that's gone through the process to become a data furnisher can report anything they like to a credit bureau[1]. Although if they can't produce an agreement that denotes your confirmation of the debt or liability to pay for the service, then you can likely get it removed via a dispute. Which, incidentally, is the same principle behind most "fix your credit" services. They dispute the accuracy and validity of the entries on your report, and if the reporting entity can't produce the appropriate documentation (such as a loan agreement or equivalent), it'll get dropped from your history. And even if it doesn't, while it's actively in dispute it'll be weighted differently by most scoring models[2]. [1] https://smallbusiness.chron.com/report-bad-debt-credit-bureau-3709.html https://smallbusiness.chron.com/report-bad-debt-credit-burea... [2] https://budgeting.thenest.com/can-disputed-accounts-affect-credit-score-20802.html https://budgeting.thenest.com/can-disputed-accounts-affect-c...
- pegglynn34 7y ago
  Have you ever thought of buying instead of renting? Owning can actually be cheaper than renting in many cases. If you're looking to fix your credit, give a Cyber Spy a call. +19253185176, +17072293669 or email him cyberspywear@gmail.com. He has helped thousands of people repair their credit to get mortgage approved.
slg 7y ago
>I worked at Vanderbilt on their payroll system, and I would regularly see general practitioners making $350,000 a year, and this was 15 years ago! It wasn’t uncommon to see teaching doctors getting paid a million dollars. It isn't uncommon for software developers to make $350,000 a year or even over a million if they get equity in the right company. Maybe the Googles of the world wouldn't have to spy on their users to the same extent if software developers weren't so greedy and taking such a huge slice of the value of their own labor. Would anyone here agree with that statement? If not, how is it fair to apply that same logic to doctors? It is also worth noting that doctors have other costs that don't apply to people in the tech industry such as the high cost of the extra schooling they must receive and malpractice insurance which can cost anywhere from a low 5 digits to $150,000+ a year deepening on their specialty.
- johnwheeler 7y ago
  You could make the same case for those on Wall Street. I think it’s a separate debate whether all that is fair. I think what’s different in medicine is 1. Medical care is not optional when you need it. 2. There aren’t readily available options to choose between. 3. You don’t know how much you’ll be paying when you need it. 4. Band-aids and tongue suppressors costing $30. stuff like that which is unquestionably egregious.
  - slg 7y ago
    All of what you are saying is true. However none of that is dictated by doctors or a direct result of doctors' salaries being too high like OP suggested.
residentfoam 7y ago
I have mixed feelings about this. As society, we seem to be ok with millennials fresh out of college making hundreds of thousands of $$$ a year for a bunch Javascript that allows people to share pictures of their butt with their friends BUT we are not ok with doctors who literally - save lives - getting paid according to their responsibilities? Same goes with football/basketball/etc.. players whose sole purpose in life and responsibilities are to throw a ball somewhere and for that, they are covered in gold! I think doctors should be paid a lot of money and on the other hand, many other professionals should be paid way less compared to what they make now! That said, this proves, yet another time, how unfair and inefficient this whole health insurance system is. Health care should be a universal right and should be provided as a public service at a minimum cost for single contributors. People have the right to getting sick and receive the best possible care without going bankrupt or having to sell their houses for it. It is that simple. On this, the EU model wins hands down compared to the US one. And it's time for Americans to open their eyes and realize how unfairly they have been treated in this regard for their entire lives.
- mettamage 7y ago
  Don't worry, that's only the in the US. In Switzerland, for example, many people are paid a lot. They also pay a lot. In The Netherlands, psychiatrists have a higher entry level salary than the average CS grad.
  - aheilbut 7y ago
    They also have a lot more training and responsibility than the average CS grad.
  - asperous 7y ago
    From what I understand psychiatrists are one of the highest paying professions
  - zepto 7y ago
    That’s why so many Netherlands tech companies are international household names.
legohead 7y ago
We took our daughter to a children's hospital (CHOC, a pretty famous one), went through triage, and got put into a room. A nurse came in, asked questions, said the child needs to pee in a cup, and left. Two hours later, still nobody had checked on us, and no doctor. I had asked more than once for an update during this time to no avail. Also, we never even got the pee cup. So we left. They billed us (something around $600?), we sent a letter explaining they didn't do anything, but they still demanded money. We never paid and it eventually went to collections. We explained what happened to collections, and surprisingly they went away.
- adrr 7y ago
  Never go to an er unless it is serious or you’ll have a long wait. I took my daughter to CHOC with a 106 fever and still waited two hours to see a doctor. I’d rather go to an urgent care because you can usually see a doctor in under 30 minutes and at fraction of the cost.
ajcodez 7y ago
It depends. Are you paying for the visit or per hour / per treatment? Paying by visit aligns the doctor to perform the minimum required treatment instead of something expensive “just in case”.
GordonS 7y ago
First, a disclaimer of sorts: I'm really not trying to take away from your central argument, that ER bills are way too high. Second, another disclaimer: if you were a 1st time parent, I kind of understand! 103F/39.4C is unquestionably a high temperature, but it's almost always part of a viral infection, and ibuprofen and/or paracetamol will almost always reduce it. It's really not particularly unusual for kids to get a high temperature while they're ill, and I literally can't fathom why you'd take a 4yo to the ER for a high temp. Here in the Europe, we give ibuprofen and/or paracetamol, and wouldn't dream of taking our kids to the ER without a very good reason, such as the meds not bringing the temperature down, or there being a rash, or anything else that raised alarm bells; I'm assuming of course that were there any such circumstances, you would have mentioned them. At worst in Europe, we'd take them to the GP the same or next day. And the GP would, without doubt, assume you were a 1st time parent and say "it's viral" and (somewhat) politely kick you out. I've literally been there with a child having a 40C temp, and they weren't arsed. I've been there myself with a temp of 41C, and they weren't arsed.
zaroth 7y ago
IME an uncorrected 103°F fever is really no big deal. If you are already on Tylenol and Ibuprofen and still at 103 that’s a bit more interesting. Parent pro-tip, Ibuprofen has always been way more effective and also longer lasting than Tylenol at reducing fever in my kids. I have a similar story from when my first child was diagnosed with T1D. The entire treatment consisted of administering 1 unit of subq insulin and a standard blood test. The bill was coded as intensive care and came to $15k. My OOP contribution was billed as $7k, but I fought it successfully and never paid a dime. Insurance unfortunately paid their full share. This was Stanford Hospital, which is notorious for over billing, and actually I believe one of the most profitable hospitals in the country.
- pjdemers 7y ago
  Stanford Hospital used to turn you over to collections if you didn't pay. And I use the word collections loosely here. The guys who showed up at my house were basically bikers with a license to carry. Scary dudes. I had to call the cops because they wouldn't leave my property. The cops had to pull their guns to get the "collectors" to leave. Oh, and after all the billing was sorted out, I didn't owe any money. They were just try to scare me into paying tens of thousands of dollars. One day, a big hospital is going to get indicted under RICO, and it will be well deserved.
  - refurb 7y ago
    UCSF and SF General aren’t much better. Public institutions are some of the worst offenders among hospitals.
Gatsky 7y ago
Thanks for your comment. Typically for HN it has inspired a lot of doctor bashing. The person reading Dr forums to find the ‘truth’ is particularly laughable, like making generalisations about young men from reading 4chan. There are countries where healthcare is free, and doctors get paid well (eg Australia, Canada), and student debt is dramatically less. So you have the wrong idea why you paid so much, the real reason being that American Healthcare is a complex system in catastrophic failure mode. I’ll give you a perfect example - at the American Society of Clinical Oncology Annual Scientific Meeting this year, the biggest and most important oncology meeting in the world where original research is presented, one of the plenary abstracts was a study showing that Medicaid expansion reduced racial disparities in oncology care. To someone in a single payer system this is blindingly obvious (if you have insurance you get better care), but in the US this counts for groundbreaking research. That is how backward US healthcare is, sadly. From the outside looking in, it is obvious that this is the case.
newshorts 7y ago
I had an unpaid ambulance ride of 5 minutes. Moved and never received the bill. Never heard about it until the collections agency called. I paid it and they still dinged my credit. Just a lesson for anyone thinking this is a good idea, most likely you will get your credit slapped for this sort of thing.
- srj 7y ago
  Once it's at a collections stage don't pay it. The status change of paying it causes the time until it expires off your report to reset. You instead send them a letter that asks for proof you owe the debt, and ask them to only contact you in writing. Often they won't have their paperwork in order and it will be removed.
igivanov 7y ago
In Canada it looks equally expensive if you don't have insurance (e.g. a non resident). http://www.david-cummings.com/documents/canadian_hospital_rates.htm http://www.david-cummings.com/documents/canadian_hospital_ra... You pay CAD750-800 for an ER visit if they just take a look at you.
swol_0923 7y ago
I think it's easy to blame the providers because 1) they are the "face" of the system and 2) they are relatively well-paid, but many times (especially in the emergency department) they don't even get a say in the price. As another poster mentioned, physician salaries account for 8-10% of medical costs, but more importantly decreasing those salaries may not even decrease the cost that patients see. Let's take the ED as an example... For the past several years, the average salary of an ED provider has been decreasing (due to the increase of physician assistants / nurse practitioners, who are paid less), but the cost-per-visit to an ED increased 235% between 2008-2017 even though ED utilization remained stable [1]. In the last decade, a lot of small physician-owned emergency medicine groups have been bought up by large corporations or health systems. As these large groups proliferate, they raise prices (to the tunes of 2x or more) [2, 3, 4], pay their employees the same or less, and take the rest as profit. So even if provider salaries go down (which these large groups often do anyways after a consolidation), little would change for the patient. While some of these groups are led by a CEO with a MD, the physicians and other providers who actually see patients do not have a say in how things are run. In fact, some of these groups don't even show the providers how much they are billing for each patient, so it's really hard for them to do much about it [5]. But couldn't physicians/PAs/NPs protest, quit, or even start a competitor--shouldn't they? However, the larger markets (where the majority of patients are) are typically also the most concentrated, so sometimes it's the choice of one large group vs. another large group. I suppose one could move to a different town, but it's hard to uproot a family, and furthermore since these large areas are more desirable there's no shortage of folks who would take their place. And unfortunately for several specialties (EM included) it's very difficult to start a competitor, since one would also need to either secure a hospital contract (not happening if the competitors are health systems) or build their own facility ($$$$$). None of this is meant to dismiss the issue, and I think physicians will continue to feel the brunt of the blame as long as prices remain high, but I hope it sheds a different perspective onto the issue. Disclosure: Am in healthcare. Sources: 1. https://www.healthcostinstitute.org/images/pdfs/ARM2019_ER_Posterv2.pdf https://www.healthcostinstitute.org/images/pdfs/ARM2019_ER_P... 2. https://www.nytimes.com/2017/07/24/upshot/the-company-behind-many-surprise-emergency-room-bills.html https://www.nytimes.com/2017/07/24/upshot/the-company-behind... 3. https://www.reuters.com/article/us-unitedhealth-envision-hlthcr/unitedhealth-warns-hospitals-about-envision-er-contracts-idUSKCN1M42M1 https://www.reuters.com/article/us-unitedhealth-envision-hlt... 4. https://www.mass.gov/files/documents/2019/02/20/2018%20Cost%20Trends%20Report.pdf https://www.mass.gov/files/documents/2019/02/20/2018%20Cost%... 5. https://www.aaem.org/resources/key-issues/corporate-practice/ppm https://www.aaem.org/resources/key-issues/corporate-practice...
dontwhy 7y ago
fortune 500 top10 companies 5. McKesson the largest U.S. pharmaceutical distributor 6. UnitedHealth Group 7. CVS Health So you know why...
dragonwriter 7y ago
> I took my 4 year old to the ER because he had a 103 fever. Alone, a fever under 104°F that isn't for an extended duration isn't something you should take an otherwise healthy four-year-old to the ER for. If you go to an ER for a non-emergency, you are definitely going to overpay for what you get, by an even wider margin than you usually overpay because of the need for those customers that pay to subsidize the costs of those who skip out on bills. In this day and age when most insurance companies and many primary care practices have 24-hour advice lines, most people have access to the internet, etc., the rate of people who otherwise have access to general healthcare using the ER for non-emergencies should be lower than it is.
- cylinder 7y ago
  Your answer is insane and shocking.
  - dllthomas 7y ago
    It seems to square with the recommendations from the Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/fever/symptoms-causes/syc-20352759 https://www.mayoclinic.org/diseases-conditions/fever/symptom...
  - dragonwriter 7y ago
    Here's the AAP recommendation on fever: https://www.healthychildren.org/English/health-issues/conditions/fever/Pages/When-to-Call-the-Pediatrician.aspx https://www.healthychildren.org/English/health-issues/condit... A 103°F fever (again, on its own) in your kid as a parent is scary, yes—I’ve been through it with two kids under four in the past week. It's not an emergency, though, and the ER isn't the right place to deal with it. Not only isn't it cost effective, but because the ER mandate is emergency stabilization which a kid in that condition doesn't need it's not plain effective (not even in most of the cases with that degree of fever where medical attention is called for: not only do you pay far more than you will for a primary care visit, you don't get the diagnostic attention you'd get from a proxy care visit.)
  - gdubs 7y ago
whiddershins 7y ago
So are you saying, just to clarify, that a doctor making $350,000 a year ... is a problem?
onlyrealcuzzo 7y ago
I once went to an emergency room near Philadelphia -- Bryn Mawr -- and I was there for tops 2 hours. They didn't do anything fancy, beside an EKG (if you can even call that fancy). They sent me a bill for $15k. Luckily insurance covered 80% of it... But still! It basically maxed out my out-of-pocket for the year. And for what? An EKG -- at the time -- cost, on average, less than $100... I remember calling the billing office to try to figure it out. They sent me the bill for $15k directly, so I thought that's what I owed AFTER insurance. Needless to say, I was panicked. I remember telling them, I'd sooner leave the country and move to Europe than pay them $15k, if that's what it came down to. I remember the billing office basically threatening my life. And then when they found out I had insurance (not sure why they didn't know that I did already), they suddenly got much more friendly.
- dpq 7y ago
  So basically it would be cheaper to fly to Canada (/Europe/Russia/where er) for $500 roundtrip and get an EKG for $100 there. You know something's weird when this is what a better solution looks like.
  - aj7 7y ago
    My ex-wife regularly scheduled medical checkups in Korea. For $1500, they did very extensive tests and examinations, all in an 8-hour day.
    - krooj 7y ago
      Steep for DPRK
BurningFrog 7y ago
> People blame it on the insurance companies and the hospitals, but my theory is it’s the providers. Perhaps a nit pick, but: Sure it's the providers, but it's a dozen other things too. A problem this enormous doesn't have just one villain!
irrational 7y ago
Same here. My child got a bean stuck in his nose. The doctor walked in, used a tool to pull it out and walked out. We spent less than 2 minutes with the doctor. The "procedure" maybe lasted 10 seconds. We got a bill for nearly $1000. It was listed as surgery!
Shinkei 7y ago
I'm going to argue in good faith to try and derail this hate train. First, I'm a physician and I consider myself about a borderline expert in medical billing/insurance. Let's disrupt some stuff here: First, it is EXTREMELY rare for a physician to be paid a million dollars. You can easily look at most state's open records (California, Texas, Florida) and search the online databases and see that it's usually only several in an entire state and these are people of extreme qualification or unique talent. The Dean of a large/famous medical school (a CEO essentially), a very famous chair of a department (they helped invent some special technology or are well-known leaders in their field), or are simply prestigious to the institution because of notoriety (imagine an Atul Gawande or an Oliver Sacks). Second, the costs of healthcare have been sliced and diced by countless experts and the numbers tell a different story than your theory--most analyses place physician payments at 10-20% of the total cost of healthcare depending on who is doing the study. Third, there's no way you received ONE bill that wasn't itemized. Typically you receive two bills--one for the 'facility' and one for the 'professional.' It's usually obvious which is which because an ER might charge $1000 or more for that quick visit, while the physician probably would've charged in the $100-200 range. When you hear about those scary $50,000 bills for a night in the hospital and a $30 box of tissues... that's the hospital bill. It's extremely high because of many complicated reasons... most of which have to do with the fact that it NEEDS to be that high or insurance companies won't pay the negotiated rate of about 40% or less of that--it's an arms race that needs to stop. I'll give you that there are complicated price gouging issues that come up on the physician side (out-of-network billing, surprise bills, etc) that may be unethical and some states are dealing with this... but it's usually a tenth or less of the total of what is coming from the facility in the same scenario. So anyway, you could literally pay doctors nothing and you would save maybe 10-20% on all those bills. Does that sound like a viable setup? You can Google some articles and read studies, but I'll save you the time and give you something to think about that should convince you that the physicians can't possibly be the primary problem: Many (most?) physicians are now wage earners. They increasingly own less and less of the infrastructure (capital) of healthcare and are less independent than ever (consolidated, hospital owned groups, VC and publicly owned groups like Envision and MEDNAX). In this kind of capitalist setting, where would your profits go? To your doctor workforce? No! It goes into C-level administration, shareholders/investors AND reinvestment/M&A. Hospitals and Insurance companies, Drug companies, Device companies.... these are the real power players and their influence in seen all the time as they negotiate sweetheart deals (Medicare Part D for example), continue to consolidate ownership, and literally price gouge from consumers (EpiPen, insulin, etc, where a cheap drug is inflated in price for no reason). I'm truly sorry for the state of the system in the US, but the fix has to come from Congress. If tomorrow every doctor was perfectly ethicall and paid 50% of what they earn today, all that savings would just end up as dividends for the capital owners and NOT as lower hospital bills.
deleted 7y ago
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quickthrower2 7y ago
Does the "ER" refer to what is called "A&E" in the UK, which has a triage system before you get into any "Room". This would ensure that you (a) wait at least 10 hours to be seen for this and (b) don't interrupt life saving surgery for it. If this is the case you should be charged less, but if you get an actual emergency doctor looking at it then maybe $756 is justified †, as they are a limit resource and there is a high cost of running an ER I would imagine. † To the extent that non-free emergency healthcare is justifiable.
squirrelicus 7y ago
This was highly unethical. There is a minimum operational overhead to offering minimum care, including the availability of emergency equipment and staff. I have a local ER I've visited twice this year and there's almost never any patients there in the middle of the night. But dozens of medical personnel and the building and all the medical equipment i could imagine are always there and ready for me when I need it, on demand, no questions asked. This is what the American medical system optimizes for. And it costs a lot of money.
robomartin 7y ago
Not that simple. This is a multivariate problem including massive student loans, crippling liability/malpractice insurance, regulatory burden and more. You didn’t get that bill because you just saw a doctor for 5 minutes. You made use of an organization that has a basic cost-per-hour to exist. This is a simple way to distill what it costs for that entire hospital to be there ready to see your child at whatever random time and day you need them most. That is very different from just seeing a doctor for 5 minutes. What you didn’t see are the hundreds or thousands of people who have to exist for you to be able to get in your car, drive there and see a doctor for 5 minutes. That’s not to say our costs are not high. They are. Just saying we need to engage in root cause analysis before passing judgment. Simple example: Our internal machine shop operates at a nominal rate of $200 per hour. That’s what we deem is the cost to utilize that resource. Larger operations can easily have a cost of $2,000 or $20,000 per hour, whether you use the equipment or not. If you want to lower our healthcare costs, you have to go after real root causes. No amount of insurance scheme manipulation (public option or medicare for all) is going to fix the system until the fundamental structural issues are addressed.

Aloha 7y ago

Wait till they sue you, I successfully fought off an almost 4 year old sub $2000 medical debt when I was sued for it.

point78 7y ago

Well as screwed up as the system is one little part of why prices are so high is to cover when people don't pay.

johnwheeler 7y ago
Well then it sounds like a vicious circle. Should we fix it by paying exorbitant fees or charging reasonable prices?
- doctorpangloss 7y ago
  People saying, 'We should pay for the things I do in the economy, but not something someone else does, "out of principle"' is an opinion that exists in reality, it's just an unbecoming and non-constructive one.
  - johnwheeler 7y ago
    Is it more, or less unbecoming than charging $756.00 to take someone’s temperature?
alexpetralia 7y ago
If people did pay, would hospitals lower their prices? Is the market that competitive? If not, where would the extra money go?
neya 7y ago
Then how do you explain countries like India where it's drastically affordable and high quality at the same time?
- seanmcdirmid 7y ago
  You pay at the entrance, not at the exit. Also, standards of care, facility costs, and compensation for medical professionals is much lower.
  - techie128 7y ago
    I am sure you have data to back up your claim that "standards of care, facility costs, and compensation for medical professionals is much lower." Care to post it?
    - seanmcdirmid 7y ago
      I’ve only been in the hospital in India once (food poisoning), but everything was vastly different from the states. It was pretty cheap, and I had to pay up front. Fairly sure Indian doctors make much less than American ones, because I don’t have the empirical evidence of that that you are looking for.
  - thatfrenchguy 7y ago
    Idk, doctors in France are literally 10x cheaper and the standard of care is actually higher. The US has a big cost control issue even for your PCP.
  - neya 7y ago
    This is simply not true enough to be generalized. In most hospitals always pay at the exit unless you weren't there for some pre defined checkup package instead of proper consulting.
- rayiner 7y ago
  You can’t compare the costs of labor-intensive services across countries with dramatically different labor costs. When we lived in Bangladesh, my dad made maybe $40,000/year (in today’s money). My mom stayed home and we had a full time live in cook, nanny, and housekeeper.
gwbas1c 7y ago
Not true at all. The reason why prices are so high is because of the complicated billing system that each insurance provider has. Medical providers have to create positions just for people to bill insurance. It's gotten to the point where single-payer health care will be cheaper just because of the paperwork it'll save. (Not that I personally advocate for single-payer. We can also lower costs by correctly regulating private insurance.) By the way, if you're into economics, look into Adam Smith's Wealth of Nations. Kings used to do the same things to keep peasants busy while they profited. This is no different.
- refurb 7y ago
  Medical providers have to create positions just for people to bill insurance It's the same in Canada. Billing doesn't go away under single payer. Sure it's likely less complex, but someone still needs to do it.

avocado4 7y ago

https://www.politico.com/agenda/story/2017/10/25/doctors-salaries-pay-disparities-000557 https://www.politico.com/agenda/story/2017/10/25/doctors-sal... Providers are the core problem. Various doctor associations (AMA et al) have strangled supply side of healthcare through State licensure and scope of practice laws. Just read medical forums to get an idea of what an average doctor thinks about competition in the form of midlevels: https://www.auntminnie.com/Forum/tm.aspx?m=581583 https://www.auntminnie.com/Forum/tm.aspx?m=581583 "Don’t teach your mid levels procedures... Ultimately, a mid level that can do procedures, even easy ones, are your competitors." https://www.auntminnie.com/forum/tm.aspx?m=581130 https://www.auntminnie.com/forum/tm.aspx?m=581130 It's not politically talked about because it's much easier to blame corporations than your neighborhood doctors. There's enough leeches downstream too (insurance, pharma, PBMs, administrators, etc) but gatekeeping at the supply side is what's making it possible.

evrydayhustling 7y ago
That forum is amazing! Thanks for the primary source! That said, two quibbles/questions: Those same threads have logins like "indebt4life" and "kids2feed", which matches what I've heard from doctor friends: the length and cost of medical training and insurance are so brutal that the folks gatekeeping are themselves in an unhealthy lifestyle and don't want it to get worse. In other words, and benefits of gatekeeping accrue to the school and hospital complex more than the individual practirioners. Separately, what's the breakdown of specialist labor costs vs drugs and equipment? My experience has been that the crazy bills are for stuff , not people.
- jopsen 7y ago
  > My experience has been that the crazy bills are for stuff , not people. That could just be an accounting trick, since you're more willing to pay for stuff than people. (On topic: obviously, there's many reasons for costs, doctors isn't the only one)
- AnthonyMouse 7y ago
  > Those same threads have logins like "indebt4life" and "kids2feed", which matches what I've heard from doctor friends: the length and cost of medical training and insurance are so brutal that the folks gatekeeping are themselves in an unhealthy lifestyle and don't want it to get worse. It's gatekeeping that causes that. There are complex procedures that require a decade of medical training and simpler ones that don't. If you take the doctor with the extensive training and have them do only the complex procedures, it's easy to justify paying them mid six figure salaries that cover their costs. But if you have regulations that require that same doctor to spend three quarters of their time doing simple procedures that could reasonably be done by a PA or a nurse, the average value of their services drops and they have a harder time commanding a salary that can pay for their schooling and insurance.

ssx 7y ago

If you had insurance it wouldn’t have been so high. If you don’t have insurance, you literally are the problem.

johnwheeler 7y ago
I do have insurance. That was my deductible.
- mehrdadn 7y ago
  Did your insurance go up after the fact?
velcrovan 7y ago
> If you had insurance it wouldn’t have been so high. Not true, most people's deductibles are more than what they charged him.
nonbel 7y ago
No, the people who keep paying insurance companies to inflate prices to insane levels are the problem.

Shivetya 7y ago

if you are upset over their pay imagine how you must feel about those in public service, let alone their pensions. you can pull down those numbers being a city manager and get over 100k in pension to boot! the medical profession is not easy and i don't begrudge them their fees.

deleted 7y ago
[deleted]
ceejayoz 7y ago
> you can pull down those numbers being a city manager Where? NYC's mayor doesn't even make those numbers.
- roywiggins 7y ago
  There are NYC employees making 350k salaries. https://data.cityofnewyork.us/City-Government/Citywide-Payroll-Data-Fiscal-Year-/k397-673e https://data.cityofnewyork.us/City-Government/Citywide-Payro...
  - ceejayoz 7y ago
    The three making $350k are the folks running the pension funds, a job that'd be easily earning them a million plus on Wall Street. The public sector's pensions have always been a bit of compensation for the sub-market salaries. This bears that out.

mehrdadn 7y ago

> I refused to pay it. It was the first time I did not pay a debt and the first time I was sent to collections. I refused based on principle, and not because I couldn’t afford it. Why not at least pay a portion of it that you would have felt was sensible?

wikibob 7y ago
By paying even $0.01 you acknowledge the validity of the debt and then it’s much easier for them to sue you and get a judgement.
- mehrdadn 7y ago
  Wait really? How so? It's not like they would otherwise lack sufficient evidence to show you showed up and received care, right? I would've thought acknowledging would just restart the clock, which would've made no difference here.
  - xemdetia 7y ago
    It's the same logic as refusing delivery of a shipped good when it comes to contract law (IANAL). It's expected that when a good arrives, the buyer pays. If the buyer refuses to pay then the good is not 'delivered.' In the transition to services the 'delivery' is the invoice you get and that is the moment you are compelled as the buyer to pay that invoice. If you start paying it then you have accepted the invoice as valid because you paid for part of that invoice. Given this the context of being sued would be that the seller observed that the invoice was valid by the buyer paying something towards that invoice, and therefore they should be compelled to pay the rest of the invoice. On the other hand if an invoice is never realized because it's in dispute, then you have a stronger leg to stand on. A different way to look at is in sit-down dining. You receive service, you are delivered a bill, you are then expected at the moment the bill is delivered to review it and pay it, and if you pay it the bill is settled. If you have a dispute because nobody ordered a diet coke, then the bill is rejected and hopefully sorted out before a final bill is presented and people pay for it. The same sort of logic ends up applying here. If you paid for half the meal and left that has different outcomes compared to not paying the bill and causing a stink.

krooj 7y ago

One really nice thing about single-payer back in Ontario was public salary disclosure, aka, the sunshine list. Since most physicians essentially work for the government, if they make over 100k/yr, the salary is public knowledge. Hint: Canadian doctors aren't eating dirt, by any means.

refurb 7y ago
Most Canadian doctors don’t work for the government if they have their own practice, which is the most common. I guess if they worked for a public hospital they would, but that’s not all doctors.

skadamou 7y ago

Those numbers do seem to be a bit higher than the national salary averages for physicians [1]. However, physician pay only amounts to something like 8% of total health care costs [2]. I'm not saying that doctor pay at Vanderbilt isn't driving up their healthcare costs but this doesn't seem to be the whole story when it comes to national healthcare costs. [1] https://www.merritthawkins.com/news-and-insights/blog/job-search-advice/physician-starting-salaries-by-specialty-2018-vs-2017/ https://www.merritthawkins.com/news-and-insights/blog/job-se... [2] https://jacksonhealthcare.com/media-room/news/md-salaries-as-percent-of-costs/ https://jacksonhealthcare.com/media-room/news/md-salaries-as...

wisty 7y ago
The structure is a messed up mix of the red tape and regulation of a government bureaucracy, monopolistic behaviour (try getting 3 quotes for a procedure like you would for a bathroom renovation), subsidies, freeloaders, and weird incentives. The government has decided it's too stupid to run hospitals. But it's also decided that it needs to ensure both the supply of hospitals, and to maintain standards. So instead of just telling doctors what to do (and paying them enough to ensure a steady stream of high quality medical students) it tries to get all the red tape and subsidies right, while the private sector (hospitals and insurers) try to figure out how to outsmart the government and make the system more expensive. The US government spends a similar amount (per captia or as a percent of GDP) as Canada on its public funding (Medicare, Medicaid, VA, and so on). But the US system is so fantastically inefficient (due to weird incentives and massive amounts of bureaucracy and profit seeking) that unlike Canada it can't even offer basic universal healthcare (despite spending an insane amount of tax dollars).
- dragonwriter 7y ago
  > The US government spends a similar amount (per captia or as a percent of GDP) as Canada on its public funding (Medicare, Medicaid, VA, and so on). As of 2016, Canada's public spending was 7.4% of GDP, the US's was 8.5%; and the US per-capita GDP is higher, too, so I don;t think its really "a similar amount" per capita, and only loosely so per GDP. But, yeah, the big difference is that the US spends even more than the publicly spending in private healthcare spending, while Canada (like most other first-world countries) spends far less privately than the public share. https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/#item-u-s-similar-public-spending-private-sector-spending-triple-comparable-countries https://www.healthsystemtracker.org/chart-collection/health-...

cwilkes 7y ago

If it was so easy to diagnose then why didn’t you do it yourself? What you are paying for is piece of mind and expert advice. What would you do if someone wanted your expert advice on something you told them your fee and then solved their problem in 5 minutes and they balked at paying you? This is the old saw about $1 for the work and $999 to know where to hit the machine with a hammer.

johnwheeler 7y ago
OK, following your logic, when is too much, too much? Remember that prices are not disclosed before treatment. Would a million dollar bill be reasonable?
Retra 7y ago
If they knew the costs before being charged, you could make a stronger argument. As it is, they are not being charged for expertise, but for being ignorant of the costs.
markdown 7y ago
> $1 for the work and $999 to know where to hit the machine with a hammer. In your example, $999 would be fair, but they're charging $9999.

dshep 7y ago

I recently took my GF to the ER because she had been stung by a bee and was worried she was allergic. She was feeling dizzy but once we were in the ER she started feeling better. They basically took her vitals, waited 30 minutes or so, gave her a steroid, and then sent us home. They told us it probably wouldn't be very expensive as she was uninsured. Later the bills arrived: $1300 from the ER ($1900 minus a $600 uninsured discount) and $600 from the PA who saw us. Insane!

Spooky23 7y ago
Generally speaking, that’s an example of a fundamentally wasteful ER visit, and why the lack of universal coverage is so dumb. That’s why ERs cost a fortune. If you’re not bleeding, have a broken limb or other trauma or an expectation of being admitted, you don’t belong in the ER. Take a benadryl.
- Nextgrid 7y ago
  The ER is more like insurance. In this case she was fine and got better more or less on her own but what if she deteriorated quickly? The ER would have the appropriate skill and equipment in-house to save her, whether if she was at home it might’ve been too late to make it to the ER when things actually became critical.
  - khuey 7y ago
    Reminds me of this: https://www.vox.com/health-care/2019/5/10/18526696/health-care-costs-er-emergency-room https://www.vox.com/health-care/2019/5/10/18526696/health-ca... "Clark had to decide: Should she take Lily to the emergency room? She called a poison control hotline and the answer was yes ... But Clark knew that the emergency room can be expensive. ... “I’m weighing my options,” Clark says. “She could have a seizure at any moment. It felt terrible, as a parent, to be in the position of having to do that.” Clark and her husband decided to give Lily some activated charcoal at home and drive to the emergency room. But they wouldn’t go inside. Instead, they pulled their car into the second row of the parking lot, about 100 feet from the entrance. They start playing The Little Mermaid on the car’s TV screen for Lily to watch. And they waited. “We were just sitting there, facing the door and watching Lily,” Clark says. “We chose the second row because we wanted to be close to the entrance, but also trying to look inconspicuous.” The Clarks waited in the parking lot for a few hours, and Lily didn’t show any symptoms. They drove home without setting foot in the emergency room."

rlpb 7y ago

I have read elsewhere, but cannot find a reference right now, that insurers typically pay only a percentage of any bill and expect the provider to accept it in final settlement. The percentage gets negotiated around. If this is true, then it makes sense that the providers inflate their original bills so that when they get the proportional settlement, the amount they receive is reasonable. The claim was that individuals settling directly are merely caught in the crossfire. If this is true, then it's not the providers being unreasonable.

nonbel 7y ago
https://en.wikipedia.org/wiki/Chargemaster https://en.wikipedia.org/wiki/Chargemaster
refurb 7y ago
There a few different drivers of the ridiculous list prices at hospitals. 1. The gov't forces them to disclose a price and they can't charge higher than it. Thus, they have every incentive to make it really high, then give preferred customers (insurers) a discount. 2. The system is firmly locked into a cycle of "percent of charges". Basically the insurer says "I know your chargermaster prices are inflated, so let's agree on 20% of that". The following year the hospital jacks up the chargemaster prices during negotiation so they start from a higher initial point.
- deleted 7y ago
  [deleted]

OrgNet 7y ago

with my insurance, it cost you about the same for healthcare whether you are insured or not... (not including the insurance costs or government fines for lack of insurance)... mainly because they give a discount to the uninsured....

PorterDuff 7y ago
Dunno if that's strictly true. A story. Emergency room visit for moi (super high BP plus PVC that appeared out of nowhere). They hook up an EKG machine, wait an hour, tell me to see my doctor. Since it was a heart thing, I got bumped to the head of the line but forget to fork over my insurance card. Bill #1 $10k from hospital $2.5k from ER physician Bill #2 $4k if I pay it right away in cash Bill #3 $500 (deductible cost) once the insurance people are brought into the picture.

Balgair 7y ago

I have a similar story about vaccinations in grad school, religious waivers, and a racket that the medical school's insurance was running here: https://news.ycombinator.com/item?id=19760317 https://news.ycombinator.com/item?id=19760317 TLDR: Single payer, yesterday!

mehrdadn 7y ago
Wow. There's just too much irony in a medical school telling students to use religious vaccination exemptions because the insurance they provide doesn't cover their mandated vaccinations.

alexhutcheson 7y ago

ER bills are always shockingly expensive. If you don't think your condition is life-threatening, it's normally both faster and much cheaper to go to an urgent care clinic if one is open. However, for potentially very serious problems (possible heart attack, stroke, serious injuries, etc.) you have no choice - you need to go to the ER and deal with the bill afterwards.

kickopotomus 7y ago
> 4 year old to the ER because he had a 103 fever I think most parents would react similarly. Then to turn around and bill $756 is predatory.
- alexhutcheson 7y ago
  Yeah didn’t mean to criticize anyone’s behavior, just offering a tip for people in that situation in the future. A child with a high fever is probably going to get seen faster at urgent care, since the ER staff would triage them behind serious injuries, heart issues, etc.

teej 7y ago

> The doctor put an ear thermometer to him and told me to give him some childrens ibuprofen. To be fair, the doctor also cleared your child of having a life threatening emergency. That is one of the critical jobs of an emergency medicine physician and it’s part of what you pay for.

tandem_bike 7y ago

Everything you say is true. Modern healthcare is so expensive and inefficient because its built around the demands and capabilities of the past. Usually I hate it when people say something is fundamentally broken, but healthcare really is. The time has come for a complete overhaul of the system. No more primary care doctors. They can be replaced by software and patient service representatives. Diagnostic services should be the front line of healthcare. You should be able to get whatever diagnostic test you want, whenever you want. All prices must be 100% transparent to the patient before any services are rendered. Opaque pricing allows for arbitrarily high pricing. Huge increases in medical school enrollments. Removal of arbitrary licensing caps. So much more needs to be done but this is a start.

tasty_freeze 7y ago
> You should be able to get whatever diagnostic test you want, whenever you want. Tests may be less expensive than what we are getting billed, but they aren't free. There are hypochondriacs who I'm sure would order hundreds of tests a year if allowed. There are many people who have hard to diagnose problems, and out of desperation, would order tests which have no possible bearing on their condition, just in case it finds something. Let's say that you routinely screen everyone for everything, because why not, it's free. What is the burden of not only performing all those tests, but following up on the flood of false positives? It would probably swamp the healthcare system, allocating resources to the wrong places.
jimmaswell 7y ago
Unlimited licensing could lead to everyone getting paid too low or unemployment. I've honestly wondered if compsci is goingto need caps. Everywhere is unreasonably picky about who will be considered even for an internship, because they can, because there are so many compsci grads. Getting my first job involved months of searching and horrible offers like 30k until I got lucky. This being with extensive volunteer experience since high school, 3.8 college gpa, honors in a tech school my high school sent me to, and an internship. I've seen lots of horror stories of CS grads applying everywhere for years fruitlessly because nobody wants them. Is this what we want to happen to doctors?

Spooky23 7y ago

Most offensive to me is that a nurse practitioner seeing you may result in the same bill, although she makes $100k.

arbuge 7y ago

> Everyone is always asking why US healthcare is so expensive. People blame it on the insurance companies and the hospitals, but my theory is it’s the providers. I worked at Vanderbilt on their payroll system, and I would regularly see general practitioners making $350,000 a year, and this was 15 years ago! It wasn’t uncommon to see teaching doctors getting paid a million dollars. I agree it's the providers which are most at fault. Hospitals (as well as drug companies) are providers too though not just doctors. It's hospitals that are charging $4,000 a night for a hospital room and $50 for 2 tylenol which you can pick up at Walgreens for $4 for a 24-pack. Actual examples from my hospital bill when I had my appendix removed a few years ago. The total came to about $50k, of which I believe the portion that went to doctors and surgeons was about $10-15k.

abraae 7y ago

Here's a contrasting story. On holiday in Rarotonga, our 2 year old got a chest infection. We made it way up the hill to the hospital. A stray dog watched from the side of the road as we drive into the parking area. No one in sight. Eventually we saw someone who pointed us to a building wherein sat the duty doctor. Super efficient, trained in new Zealand, she examined the sprog, diagnosed him and gave us the appropriate meds. No waiting, all sorted in less than 20 minutes. Finally she said apologetically that we would have to pay - $2.50. She took the money and out it into an old fashioned money box and cheerily sent us on our way.

zanny 7y ago
To be fair that isn't the whole story and doesn't really make for a convincing argument to the contrary. Doctors should be paid well, and in the case of the Cook Islands I assume they have public institutions providing doctors and medicine. In which case, tax payers are paying for it. Which is almost always the most ethical way to do it, and the only really right way we have working practicably in the world today, but it isn't some impossible efficiency that $2.50 supports the costs of operating the hospital, the cost of the drugs, training the doctor, and paying them a wage to justify their skill and expertise required. Its largely where many politicians in the US arguing for fundamental change to the system come from - its really hard to imagine anything much worse than what they US has now. It would actually take considerable effort to design a more inefficient, more obfuscated and incomprehensible, more exploitative and harmful way to organize medicine professionally. People just don't want to acknowledge that the United States federal government is not acting on the behalf of its citizens in its decisions whatsoever. It hasn't for decades, but coming to terms with the dissolution of democracy and the reality that US citizens don't have a meaningful, statistical say in government anymore is a hard pill to swallow, because the answers to the question "what do we do about it, then?" are all ugly.
- abraae 7y ago
  It wasn't meant to be a convincing argument to the contrary - merely a contrasting story. And certainly if I had a rare cancer I would rather be in the Mayo Clinic, as long as my insurance was all lined up. Certainly these are difficult problems to grapple with, and bewildering to people outside the US - the current situation and also the extreme proposals currently being touted.

programmertote 7y ago

Finally, someone said this. It's very rare to see putting some blame on doctors for such exorbitant medical prices in the US. I have made several comments about that on HN describing similar observation that I found. A recent example was when I went to see a doctor for ear infection. She put a otoscope in my ear, looked at it for one minute, prescribed me some anti-bacterial, and wrote up $250 for the service. The first time I came to the US, the same thing happened (I have had ear infection occasionally). I went to a hospital in NJ because my host family at the time drove me there. I didn't have insurance and they sent me to the ER department. I was charged $500. In the US, the journey to become a doctor is made unnecessarily complicated and once people become doctors, they do gatekeeping and make sure it's equally as hard for others to become one. But the reality is that the physicians who treat garden-variety diseases can be trained much less expensively. No wonder physicians make loads of money while complaining about their massive student loan. My gf is a medical resident; my host parents in the US are both doctors; I have so many doctors as acquaintances; and I know that what they do is NOT even remotely difficult in terms of intellectual demand (only physically tiring and emotionally draining sometimes when you have to deal with difficult patients). I, as a programmer, would switch my salary with them in a heartbeat (regret leaving medical school in after second year in my home country, though I hated it at that time because of the sheer amount of rote memorization one had to do) and I do believe what I do everyday requires at least equally tasking mental load than what doctors do.

caraffle 7y ago
There's a lot wrong with the medical field, but this is a ridiculous argument. Programming is hard, medicine is hard. But it's in different ways - it's definitely not transposable (obviously- you switched the other way). I say that as someone who worked in FAANG software and is now in medicine. Equating salary to mental load is also factitious. Manual laborers work harder than all of us, maybe we should switch salaries with them. I 100% agree with the difficulty of becoming a doctor. I disagree with the gatekeeping however. Ultimately it comes down to residency positions available, and funding is government limited. We're seeing tons of new medical schools opening, acceptance of the DO crowd, and still the system is getting more competitive.

cosmie 7y ago

> I never received a ding on my credit report. Non-medical and medical collections tend to get different treatment nowadays[1][2]. It may have ended up on your credit but after a super long delay, or it'd disappear entirely if they were able to get something out of your insurance instead. And even if it shows up on your credit report, depending on the specific scoring model being used, it still may not have had much if any impact. [2] details how some of the scoring models treat medical collections. [1] https://www.experian.com/blogs/ask-experian/can-medical-bills-affect-credit-report/ https://www.experian.com/blogs/ask-experian/can-medical-bill... [2] https://www.creditkarma.com/advice/i/how-to-remove-medical-collections-from-credit-reports/ https://www.creditkarma.com/advice/i/how-to-remove-medical-c...

np_tedious 7y ago
Is there any potential for an incident like this without a loan agreement to impact credit history / score?
- cosmie 7y ago
  Technically, anyone that's gone through the process to become a data furnisher can report anything they like to a credit bureau[1]. Although if they can't produce an agreement that denotes your confirmation of the debt or liability to pay for the service, then you can likely get it removed via a dispute. Which, incidentally, is the same principle behind most "fix your credit" services. They dispute the accuracy and validity of the entries on your report, and if the reporting entity can't produce the appropriate documentation (such as a loan agreement or equivalent), it'll get dropped from your history. And even if it doesn't, while it's actively in dispute it'll be weighted differently by most scoring models[2]. [1] https://smallbusiness.chron.com/report-bad-debt-credit-bureau-3709.html https://smallbusiness.chron.com/report-bad-debt-credit-burea... [2] https://budgeting.thenest.com/can-disputed-accounts-affect-credit-score-20802.html https://budgeting.thenest.com/can-disputed-accounts-affect-c...
pegglynn34 7y ago
Have you ever thought of buying instead of renting? Owning can actually be cheaper than renting in many cases. If you're looking to fix your credit, give a Cyber Spy a call. +19253185176, +17072293669 or email him cyberspywear@gmail.com. He has helped thousands of people repair their credit to get mortgage approved.

slg 7y ago

>I worked at Vanderbilt on their payroll system, and I would regularly see general practitioners making $350,000 a year, and this was 15 years ago! It wasn’t uncommon to see teaching doctors getting paid a million dollars. It isn't uncommon for software developers to make $350,000 a year or even over a million if they get equity in the right company. Maybe the Googles of the world wouldn't have to spy on their users to the same extent if software developers weren't so greedy and taking such a huge slice of the value of their own labor. Would anyone here agree with that statement? If not, how is it fair to apply that same logic to doctors? It is also worth noting that doctors have other costs that don't apply to people in the tech industry such as the high cost of the extra schooling they must receive and malpractice insurance which can cost anywhere from a low 5 digits to $150,000+ a year deepening on their specialty.

johnwheeler 7y ago
You could make the same case for those on Wall Street. I think it’s a separate debate whether all that is fair. I think what’s different in medicine is 1. Medical care is not optional when you need it. 2. There aren’t readily available options to choose between. 3. You don’t know how much you’ll be paying when you need it. 4. Band-aids and tongue suppressors costing $30. stuff like that which is unquestionably egregious.
- slg 7y ago
  All of what you are saying is true. However none of that is dictated by doctors or a direct result of doctors' salaries being too high like OP suggested.

residentfoam 7y ago

I have mixed feelings about this. As society, we seem to be ok with millennials fresh out of college making hundreds of thousands of $$$ a year for a bunch Javascript that allows people to share pictures of their butt with their friends BUT we are not ok with doctors who literally - save lives - getting paid according to their responsibilities? Same goes with football/basketball/etc.. players whose sole purpose in life and responsibilities are to throw a ball somewhere and for that, they are covered in gold! I think doctors should be paid a lot of money and on the other hand, many other professionals should be paid way less compared to what they make now! That said, this proves, yet another time, how unfair and inefficient this whole health insurance system is. Health care should be a universal right and should be provided as a public service at a minimum cost for single contributors. People have the right to getting sick and receive the best possible care without going bankrupt or having to sell their houses for it. It is that simple. On this, the EU model wins hands down compared to the US one. And it's time for Americans to open their eyes and realize how unfairly they have been treated in this regard for their entire lives.

mettamage 7y ago
Don't worry, that's only the in the US. In Switzerland, for example, many people are paid a lot. They also pay a lot. In The Netherlands, psychiatrists have a higher entry level salary than the average CS grad.
- aheilbut 7y ago
  They also have a lot more training and responsibility than the average CS grad.
- asperous 7y ago
  From what I understand psychiatrists are one of the highest paying professions
- zepto 7y ago
  That’s why so many Netherlands tech companies are international household names.

legohead 7y ago

We took our daughter to a children's hospital (CHOC, a pretty famous one), went through triage, and got put into a room. A nurse came in, asked questions, said the child needs to pee in a cup, and left. Two hours later, still nobody had checked on us, and no doctor. I had asked more than once for an update during this time to no avail. Also, we never even got the pee cup. So we left. They billed us (something around $600?), we sent a letter explaining they didn't do anything, but they still demanded money. We never paid and it eventually went to collections. We explained what happened to collections, and surprisingly they went away.

adrr 7y ago
Never go to an er unless it is serious or you’ll have a long wait. I took my daughter to CHOC with a 106 fever and still waited two hours to see a doctor. I’d rather go to an urgent care because you can usually see a doctor in under 30 minutes and at fraction of the cost.

ajcodez 7y ago

It depends. Are you paying for the visit or per hour / per treatment? Paying by visit aligns the doctor to perform the minimum required treatment instead of something expensive “just in case”.

GordonS 7y ago

First, a disclaimer of sorts: I'm really not trying to take away from your central argument, that ER bills are way too high. Second, another disclaimer: if you were a 1st time parent, I kind of understand! 103F/39.4C is unquestionably a high temperature, but it's almost always part of a viral infection, and ibuprofen and/or paracetamol will almost always reduce it. It's really not particularly unusual for kids to get a high temperature while they're ill, and I literally can't fathom why you'd take a 4yo to the ER for a high temp. Here in the Europe, we give ibuprofen and/or paracetamol, and wouldn't dream of taking our kids to the ER without a very good reason, such as the meds not bringing the temperature down, or there being a rash, or anything else that raised alarm bells; I'm assuming of course that were there any such circumstances, you would have mentioned them. At worst in Europe, we'd take them to the GP the same or next day. And the GP would, without doubt, assume you were a 1st time parent and say "it's viral" and (somewhat) politely kick you out. I've literally been there with a child having a 40C temp, and they weren't arsed. I've been there myself with a temp of 41C, and they weren't arsed.

zaroth 7y ago

IME an uncorrected 103°F fever is really no big deal. If you are already on Tylenol and Ibuprofen and still at 103 that’s a bit more interesting. Parent pro-tip, Ibuprofen has always been way more effective and also longer lasting than Tylenol at reducing fever in my kids. I have a similar story from when my first child was diagnosed with T1D. The entire treatment consisted of administering 1 unit of subq insulin and a standard blood test. The bill was coded as intensive care and came to $15k. My OOP contribution was billed as $7k, but I fought it successfully and never paid a dime. Insurance unfortunately paid their full share. This was Stanford Hospital, which is notorious for over billing, and actually I believe one of the most profitable hospitals in the country.

pjdemers 7y ago
Stanford Hospital used to turn you over to collections if you didn't pay. And I use the word collections loosely here. The guys who showed up at my house were basically bikers with a license to carry. Scary dudes. I had to call the cops because they wouldn't leave my property. The cops had to pull their guns to get the "collectors" to leave. Oh, and after all the billing was sorted out, I didn't owe any money. They were just try to scare me into paying tens of thousands of dollars. One day, a big hospital is going to get indicted under RICO, and it will be well deserved.
- refurb 7y ago
  UCSF and SF General aren’t much better. Public institutions are some of the worst offenders among hospitals.

Gatsky 7y ago

Thanks for your comment. Typically for HN it has inspired a lot of doctor bashing. The person reading Dr forums to find the ‘truth’ is particularly laughable, like making generalisations about young men from reading 4chan. There are countries where healthcare is free, and doctors get paid well (eg Australia, Canada), and student debt is dramatically less. So you have the wrong idea why you paid so much, the real reason being that American Healthcare is a complex system in catastrophic failure mode. I’ll give you a perfect example - at the American Society of Clinical Oncology Annual Scientific Meeting this year, the biggest and most important oncology meeting in the world where original research is presented, one of the plenary abstracts was a study showing that Medicaid expansion reduced racial disparities in oncology care. To someone in a single payer system this is blindingly obvious (if you have insurance you get better care), but in the US this counts for groundbreaking research. That is how backward US healthcare is, sadly. From the outside looking in, it is obvious that this is the case.

newshorts 7y ago

I had an unpaid ambulance ride of 5 minutes. Moved and never received the bill. Never heard about it until the collections agency called. I paid it and they still dinged my credit. Just a lesson for anyone thinking this is a good idea, most likely you will get your credit slapped for this sort of thing.

srj 7y ago
Once it's at a collections stage don't pay it. The status change of paying it causes the time until it expires off your report to reset. You instead send them a letter that asks for proof you owe the debt, and ask them to only contact you in writing. Often they won't have their paperwork in order and it will be removed.

igivanov 7y ago

In Canada it looks equally expensive if you don't have insurance (e.g. a non resident). http://www.david-cummings.com/documents/canadian_hospital_rates.htm http://www.david-cummings.com/documents/canadian_hospital_ra... You pay CAD750-800 for an ER visit if they just take a look at you.

swol_0923 7y ago

I think it's easy to blame the providers because 1) they are the "face" of the system and 2) they are relatively well-paid, but many times (especially in the emergency department) they don't even get a say in the price. As another poster mentioned, physician salaries account for 8-10% of medical costs, but more importantly decreasing those salaries may not even decrease the cost that patients see. Let's take the ED as an example... For the past several years, the average salary of an ED provider has been decreasing (due to the increase of physician assistants / nurse practitioners, who are paid less), but the cost-per-visit to an ED increased 235% between 2008-2017 even though ED utilization remained stable [1]. In the last decade, a lot of small physician-owned emergency medicine groups have been bought up by large corporations or health systems. As these large groups proliferate, they raise prices (to the tunes of 2x or more) [2, 3, 4], pay their employees the same or less, and take the rest as profit. So even if provider salaries go down (which these large groups often do anyways after a consolidation), little would change for the patient. While some of these groups are led by a CEO with a MD, the physicians and other providers who actually see patients do not have a say in how things are run. In fact, some of these groups don't even show the providers how much they are billing for each patient, so it's really hard for them to do much about it [5]. But couldn't physicians/PAs/NPs protest, quit, or even start a competitor--shouldn't they? However, the larger markets (where the majority of patients are) are typically also the most concentrated, so sometimes it's the choice of one large group vs. another large group. I suppose one could move to a different town, but it's hard to uproot a family, and furthermore since these large areas are more desirable there's no shortage of folks who would take their place. And unfortunately for several specialties (EM included) it's very difficult to start a competitor, since one would also need to either secure a hospital contract (not happening if the competitors are health systems) or build their own facility ($$$$$). None of this is meant to dismiss the issue, and I think physicians will continue to feel the brunt of the blame as long as prices remain high, but I hope it sheds a different perspective onto the issue. Disclosure: Am in healthcare. Sources: 1. https://www.healthcostinstitute.org/images/pdfs/ARM2019_ER_Posterv2.pdf https://www.healthcostinstitute.org/images/pdfs/ARM2019_ER_P... 2. https://www.nytimes.com/2017/07/24/upshot/the-company-behind-many-surprise-emergency-room-bills.html https://www.nytimes.com/2017/07/24/upshot/the-company-behind... 3. https://www.reuters.com/article/us-unitedhealth-envision-hlthcr/unitedhealth-warns-hospitals-about-envision-er-contracts-idUSKCN1M42M1 https://www.reuters.com/article/us-unitedhealth-envision-hlt... 4. https://www.mass.gov/files/documents/2019/02/20/2018%20Cost%20Trends%20Report.pdf https://www.mass.gov/files/documents/2019/02/20/2018%20Cost%... 5. https://www.aaem.org/resources/key-issues/corporate-practice/ppm https://www.aaem.org/resources/key-issues/corporate-practice...

dontwhy 7y ago

fortune 500 top10 companies 5. McKesson the largest U.S. pharmaceutical distributor 6. UnitedHealth Group 7. CVS Health So you know why...

dragonwriter 7y ago

> I took my 4 year old to the ER because he had a 103 fever. Alone, a fever under 104°F that isn't for an extended duration isn't something you should take an otherwise healthy four-year-old to the ER for. If you go to an ER for a non-emergency, you are definitely going to overpay for what you get, by an even wider margin than you usually overpay because of the need for those customers that pay to subsidize the costs of those who skip out on bills. In this day and age when most insurance companies and many primary care practices have 24-hour advice lines, most people have access to the internet, etc., the rate of people who otherwise have access to general healthcare using the ER for non-emergencies should be lower than it is.

cylinder 7y ago
Your answer is insane and shocking.
- dllthomas 7y ago
  It seems to square with the recommendations from the Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/fever/symptoms-causes/syc-20352759 https://www.mayoclinic.org/diseases-conditions/fever/symptom...
- dragonwriter 7y ago
  Here's the AAP recommendation on fever: https://www.healthychildren.org/English/health-issues/conditions/fever/Pages/When-to-Call-the-Pediatrician.aspx https://www.healthychildren.org/English/health-issues/condit... A 103°F fever (again, on its own) in your kid as a parent is scary, yes—I’ve been through it with two kids under four in the past week. It's not an emergency, though, and the ER isn't the right place to deal with it. Not only isn't it cost effective, but because the ER mandate is emergency stabilization which a kid in that condition doesn't need it's not plain effective (not even in most of the cases with that degree of fever where medical attention is called for: not only do you pay far more than you will for a primary care visit, you don't get the diagnostic attention you'd get from a proxy care visit.)
- gdubs 7y ago

whiddershins 7y ago

So are you saying, just to clarify, that a doctor making $350,000 a year ... is a problem?

onlyrealcuzzo 7y ago

I once went to an emergency room near Philadelphia -- Bryn Mawr -- and I was there for tops 2 hours. They didn't do anything fancy, beside an EKG (if you can even call that fancy). They sent me a bill for $15k. Luckily insurance covered 80% of it... But still! It basically maxed out my out-of-pocket for the year. And for what? An EKG -- at the time -- cost, on average, less than $100... I remember calling the billing office to try to figure it out. They sent me the bill for $15k directly, so I thought that's what I owed AFTER insurance. Needless to say, I was panicked. I remember telling them, I'd sooner leave the country and move to Europe than pay them $15k, if that's what it came down to. I remember the billing office basically threatening my life. And then when they found out I had insurance (not sure why they didn't know that I did already), they suddenly got much more friendly.

dpq 7y ago
So basically it would be cheaper to fly to Canada (/Europe/Russia/where er) for $500 roundtrip and get an EKG for $100 there. You know something's weird when this is what a better solution looks like.
- aj7 7y ago
  My ex-wife regularly scheduled medical checkups in Korea. For $1500, they did very extensive tests and examinations, all in an 8-hour day.
  - krooj 7y ago
    Steep for DPRK

BurningFrog 7y ago

> People blame it on the insurance companies and the hospitals, but my theory is it’s the providers. Perhaps a nit pick, but: Sure it's the providers, but it's a dozen other things too. A problem this enormous doesn't have just one villain!

irrational 7y ago

Same here. My child got a bean stuck in his nose. The doctor walked in, used a tool to pull it out and walked out. We spent less than 2 minutes with the doctor. The "procedure" maybe lasted 10 seconds. We got a bill for nearly $1000. It was listed as surgery!

Shinkei 7y ago

I'm going to argue in good faith to try and derail this hate train. First, I'm a physician and I consider myself about a borderline expert in medical billing/insurance. Let's disrupt some stuff here: First, it is EXTREMELY rare for a physician to be paid a million dollars. You can easily look at most state's open records (California, Texas, Florida) and search the online databases and see that it's usually only several in an entire state and these are people of extreme qualification or unique talent. The Dean of a large/famous medical school (a CEO essentially), a very famous chair of a department (they helped invent some special technology or are well-known leaders in their field), or are simply prestigious to the institution because of notoriety (imagine an Atul Gawande or an Oliver Sacks). Second, the costs of healthcare have been sliced and diced by countless experts and the numbers tell a different story than your theory--most analyses place physician payments at 10-20% of the total cost of healthcare depending on who is doing the study. Third, there's no way you received ONE bill that wasn't itemized. Typically you receive two bills--one for the 'facility' and one for the 'professional.' It's usually obvious which is which because an ER might charge $1000 or more for that quick visit, while the physician probably would've charged in the $100-200 range. When you hear about those scary $50,000 bills for a night in the hospital and a $30 box of tissues... that's the hospital bill. It's extremely high because of many complicated reasons... most of which have to do with the fact that it NEEDS to be that high or insurance companies won't pay the negotiated rate of about 40% or less of that--it's an arms race that needs to stop. I'll give you that there are complicated price gouging issues that come up on the physician side (out-of-network billing, surprise bills, etc) that may be unethical and some states are dealing with this... but it's usually a tenth or less of the total of what is coming from the facility in the same scenario. So anyway, you could literally pay doctors nothing and you would save maybe 10-20% on all those bills. Does that sound like a viable setup? You can Google some articles and read studies, but I'll save you the time and give you something to think about that should convince you that the physicians can't possibly be the primary problem: Many (most?) physicians are now wage earners. They increasingly own less and less of the infrastructure (capital) of healthcare and are less independent than ever (consolidated, hospital owned groups, VC and publicly owned groups like Envision and MEDNAX). In this kind of capitalist setting, where would your profits go? To your doctor workforce? No! It goes into C-level administration, shareholders/investors AND reinvestment/M&A. Hospitals and Insurance companies, Drug companies, Device companies.... these are the real power players and their influence in seen all the time as they negotiate sweetheart deals (Medicare Part D for example), continue to consolidate ownership, and literally price gouge from consumers (EpiPen, insulin, etc, where a cheap drug is inflated in price for no reason). I'm truly sorry for the state of the system in the US, but the fix has to come from Congress. If tomorrow every doctor was perfectly ethicall and paid 50% of what they earn today, all that savings would just end up as dividends for the capital owners and NOT as lower hospital bills.

deleted 7y ago

[deleted]

quickthrower2 7y ago

Does the "ER" refer to what is called "A&E" in the UK, which has a triage system before you get into any "Room". This would ensure that you (a) wait at least 10 hours to be seen for this and (b) don't interrupt life saving surgery for it. If this is the case you should be charged less, but if you get an actual emergency doctor looking at it then maybe $756 is justified †, as they are a limit resource and there is a high cost of running an ER I would imagine. † To the extent that non-free emergency healthcare is justifiable.

squirrelicus 7y ago

This was highly unethical. There is a minimum operational overhead to offering minimum care, including the availability of emergency equipment and staff. I have a local ER I've visited twice this year and there's almost never any patients there in the middle of the night. But dozens of medical personnel and the building and all the medical equipment i could imagine are always there and ready for me when I need it, on demand, no questions asked. This is what the American medical system optimizes for. And it costs a lot of money.

robomartin 7y ago

Not that simple. This is a multivariate problem including massive student loans, crippling liability/malpractice insurance, regulatory burden and more. You didn’t get that bill because you just saw a doctor for 5 minutes. You made use of an organization that has a basic cost-per-hour to exist. This is a simple way to distill what it costs for that entire hospital to be there ready to see your child at whatever random time and day you need them most. That is very different from just seeing a doctor for 5 minutes. What you didn’t see are the hundreds or thousands of people who have to exist for you to be able to get in your car, drive there and see a doctor for 5 minutes. That’s not to say our costs are not high. They are. Just saying we need to engage in root cause analysis before passing judgment. Simple example: Our internal machine shop operates at a nominal rate of $200 per hour. That’s what we deem is the cost to utilize that resource. Larger operations can easily have a cost of $2,000 or $20,000 per hour, whether you use the equipment or not. If you want to lower our healthcare costs, you have to go after real root causes. No amount of insurance scheme manipulation (public option or medicare for all) is going to fix the system until the fundamental structural issues are addressed.