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Medical equipment pricing is completely broken when a sling costs $200
- ericd 7y agoWe had a call with someone who works on the pricelist/chargemaster for a major metro hospital recently, they set their prices by taking the Medicare reimbursement rate, and multiplying by 8.
- Gibbon1 7y agoIf any other business tried billing people like hospitals and doctors do, people would go to prison.
- pkulak 7y agoAt least if it was an inelastic good like health care. Gas goes up a quarter and elected officials are thrown out of office. $600 for a drop of super glue? Okay then.
- AaronFriel 7y agoThat $600 is just monopoly money to the majority of constituents, because they have insurance of some kind or they're on Medicare/Medicaid. So those people are usually, not always, but usually fine. And that of course is part of the problem. Medical billing is like playing numberwang or who's line is it anyway. No two numbers on a bill seem to be correlated in any way to another except as upper or lower bounds. When someone without coverage comes in then, they have to play that stupid game with all the numbers, and of course they either ignore it and go into debt, pay the cash price if they're able, or they manage to negotiate it down by orders of magnitude - proving the price didn't matter anyway.
- deleted 7y ago[deleted]
- Ididntdothis 7y agoThat’s what i don’t get. A lot of the billing is clearly fraudulent. They routinely bill for treatments that never happened or for drugs that were never given.
- teej 7y agoHospitals that take a majority Medicare patients go out of business. Medicare patients are subsidized by the rest of a hospital’s patient population.
- Retric 7y agoThat’s a common but false talking point. Hospitals with above average Medicare patients generally get paid more than the general population. It’s also a question of what percentage of a nominal bill gets paid vs sent to collections.
- AnimalMuppet 7y agoGiven that it's a common misconception, would you supply some evidence for your position?
- Retric 7y agoHospitals receive extra payments when they have an unusual number of Medicare patients. https://www.medicaid.gov/medicaid/finance/dsh/index.html https://www.medicaid.gov/medicaid/finance/dsh/index.html It’s just another case where the government splits spending across multiple programs.
- AnimalMuppet 7y agoI didn't know that program existed. Still, I don't see that the existence of the program adds up to your assertion: > Hospitals with above average Medicare patients generally get paid more than the general population.
- mattmcknight 7y agoThat's Medicaid, not Medicare
- refurb 7y agoWhen they have a disproportionate share of Medicaid, not Medicare patients. And the added payment isn’t that much. Generally Medicaid pays below cost. Medicare is reasonable and leaves providers with a small profit (single digit percentage).
- mattmcknight 7y agoSimple change to next year's Medicare plans: if you accept Medicare you cannot charge any patient more than you charge Medicare.
- noelsusman 7y agoSimple way to put most hospitals out of business overnight. Or, more likely, simple way to force hospitals to make drastic cuts to services.
- mattmcknight 7y agoOr Medicare prices rise to be closer to real costs, instead of forcing them to be subsidized by the uninsured.
- hollerith 7y agoThat was tried during the Clinton administration. Result: many doctors dropped all their Medicare patients, making it impractical for Medicare patients to find a doctor to treat certain conditions.
- mattmcknight 7y agoThen Medicare needs to pay a little more for those specialists.
- noelsusman 7y agoThis is pretty common. Uninsured patients are such a small percentage of revenue (and many aren't going to pay anyway) that hospitals don't put much effort into setting prices. Negotiating with insurers and navigating billing them is a big operation as it is.
- ericd 7y agoYeah, and there’s the Lesser Of clause in their insurance contracts - they’ll be reimbursed at the lesser of their retail rate and their negotiated rate. So they make their retail rate ridiculously high to make sure it’s never the limiter for insurance payments.
- PorterDuff 7y ago" they set their prices by taking the Medicare reimbursement rate, and multiplying by 8." lol. Seriously? Well it's a simple system. I wonder what happens when it's Medicare-for-all. Do they make 1/8 as much all of a sudden?
- rolph 7y agoi wonder if a hospital would still charge you if you refused thier price gouge materials and used your own purchased at a proper price, as in "thanks for setting the bone, i dont need your sling i have my own and it will do fine, here is my lawyers contact card."
- save_ferris 7y ago“OK, the cost of setting that bone just went up $900.” That’s probably what they would do. We know that they don’t base prices in any kind of rationally economic way.
- rolph 7y agohence the lawyers contact card.
- coreyoconnor 7y agoIIRC prior to being treated you agree to be financially liable for the costs. Prior to even knowing that that will be or even the costs involved. Or even if you know what is involved are you going to understand what a reasonable cost is? EG: Sling is easy but what about a x-ray study? Is that 200$ or $150? Just like a proper capitalist system! You know, like when you agreed to pay whatever for your iPhone prior to even know it'll work.
- merpnderp 7y agoWe don’t have a capitalist system, we have the worst of all possible systems. There’s no competition, yet the state doesn’t control the prices.
- inetknght 7y ago> You know, like when you agreed to pay whatever for your iPhone prior to even know it'll work. I can contact Apple for help with any issues I have with my iPhone. I can contact my carrier for any issues I have with my iPhone. I can return my iPhone within a grace period if I don't like it. Try doing any of that for medical costs.
- brink 7y agoI just got an itemized bill today for a minor fall I took a couple months back.. On top of the nearly $6k in other charges from the hospital, they charged $531 for one dab of superglue or "liquid stitches" on my forehead for something that would have healed by itself. One of my friends died two years ago from pneumonia. He didn't go to the hospital when symptoms first started because he was afraid of the bills that would come from it. They don't ask you if you want to spend $500 for a dab of glue on your forehead, they just do it and you're essentially writing them a blank check in the process. I hate our medical system.
- throwaway1777 7y agoPretty sure if you go through the effort to challenge such charges you can get them changed. https://www.vox.com/2019/3/22/18261698/how-to-fight-expensive-medical-bill https://www.vox.com/2019/3/22/18261698/how-to-fight-expensiv...
- widowlark 7y agoYou would need to do this for every change, every time. Hardly a good solution.
- hayksaakian 7y agoOpt-out vs Opt-in
- Ididntdothis 7y agoYou need very strong nerves. Their collectors can be very aggressive.
- chachachoney 7y agoIncredibly useful phrase: "I'd love to get this in front of a judge."
- mehrdadn 7y agoThe thing I don't understand about tips like these is, what obligation does the other party have to cooperate at all? Like you "ask for a supervisor" (and then a director!) what incentive do they have to not just say no? Or if you ask for an itemized bill, what if they just refuse? How are you supposed to get past a blunt refusal, which to me seems like the easiest response for them?
- droithomme 7y ago> Hillary Schuler-Jones, a Breg spokeswoman, declined to answer questions about the price of the Deluxe Shoulder Immobilizer. “It is important to note,” she said, “that Breg’s customer is not the patient, but the healthcare provider.” In most cases, “we don’t sell our products directly to patients, and we therefore don’t have a patient price list.” This is pretty infuriating given that the article previously said that Breg directly billed the patient in a "surprise billing". A company with seemingly no connection to the hospital directly bills the patient $200 for a $12 item and then when asked about this by a journalist says "We don't sell direct to patients" and refuses all further comment. If they don't ever sell direct to patients then the bill must be fraudulent, sent by an imposter. Curiously enough last year I received one of these sorts of fraudulent scam bills. A traffic camera ticket. It had my name but no street identified, no license plate or car description, no drivers license number, and no photo of the alleged infraction. The mailing address was to a location far away from the city, neither location which I had driven in recently, and the company I was supposed to write the check to didn't have a lot of information about who they were online. I was not allowed to contest it unless I signed an agreement to accept private arbitration results. I went to the city it allegedly came from and asked at their courthouse about it and the clerk told me "You are required to pay this" but said she was not able to verify anything about the ticket, give me a license plate number, or the name of an intersection or photograph, referring me instead to the arbitration and saying that "privacy laws" prevented her from saying anything else. So I didn't pay it, ignored it and never heard about it again. As far as I'm concerned it was a scam. If it really came from the city it was unconstitutional because there was no due process. It also wasn't served, it was mailed bulk rate and not even registered, which such mailing is not a valid server process in this jurisdiction. Given that this company Breg says they don't sell to patients, the patient has a legal basis for refusing to pay this bill claiming to be sent from them, because the company itself has claimed in an official statement to a journalist that the bill is fraudulent.
- RandomBacon 7y ago> asked at their courthouse about it and the clerk told me Sounds like they were in on the scam. What would be the appropriate method to legally-resolve this and shut it down? Contact the state's Attorney General?
- supernova87a 7y agoWell, popcorn in a movie theater also costs 10x more than it should, because they have you as a captive audience. And it doesn't help that the price is basically opaque and paid for by insurance, for a person who doesn't care about the price at that moment. It's a ridiculous system.
- ceejayoz 7y agoI get the price of the popcorn up front, and I don’t die if I skip it.
- altmind 7y agoMovie theater does not give you the popcorn and tell you the price a week after. Also, you can say no to the popcorn in a movie theater; you cannot control the fine details of your treatment.
- blisterpeanuts 7y agoA movie just isn't the same without popcorn :) And you're a captive audience; they don't allow you to bring in your own supply.
- salawat 7y agoThis is why I've considered and End-Server License Agreement. In providing service to me as a User, yada-yada-yada yada. If I actually went through the trouble of formally writing one up, and spreading it far and wide on the winds, and could actually get a significant portion of the population serving it in instances of predatory policy/pricing, and refusing the product such that a meaningful impact was made on service provider's bottom line, I've often wondered whether or not an equilibrium could finally be established where businesses stopped looking at customers who don't complain as people not yet sufficiently fleeced.
- HillaryBriss 7y agoyes. something is very wrong. everyone in America has known that for decades. the LA Times very often states the obvious in its headlines.
- diogenescynic 7y agoReposting s comment I saw on something similar: >My wife has Stage IV breast cancer. She has been a public school teacher for 20 years and we have pretty good health insurance. She continues to work. She will teach as long as she can because she wants to...and financially she will need to. >Even with good health coverage, we have STILL spent thousands of dollars the past couple years out of pocket. If/when she takes medical retirement, it will get much worse. It will cost her 75% of her retirement income just to purchase health insurance. The rest will go to copays, gas for hospital trips, etc. Oh by the way, we still pay thousands in federal taxes each year, while corporations and the rich avoid most taxes and pay very little. It's fucking criminal. Fuck everyone who developed this system and fights to maintain it. From this thread on medical bankruptcy being a uniquely American phenomena: https://www.reddit.com/r/politics/comments/d10ab6/medical_bankruptcy_is_an_american_scandal_and/ezgp0mc/ https://www.reddit.com/r/politics/comments/d10ab6/medical_ba...
- Ididntdothis 7y agoI have seen this with people who had cancer. Even with insurance they slowly got sucked dry. They spend hours and hours on the phone with insurance and doctors and if you don’t have a lawyer on retainer or really good nerves all the billing mistakes slowly bankrupt you. It’s a horrible system where the patient is just a football to be kicked around between hospitals, doctors and insurance.
- narrator 7y agoThis is why I like Kaiser so much. If you make it to a Kaiser emergency room, and you have Kaiser health insurance, you are not going to get an out-of-network surprise bill. Everyone at Kaiser works for Kaiser and is paid a salary by Kaiser and the Kaiser hospital is the only one that bills you.
- mdorazio 7y ago... what if you don't make it to a Kaiser emergency room? The Kaiser system would be great if every major hospital nationwide was under it. Kind of like a national healthcare system...
- henryfjordan 7y agoKaiser covers ER trips to other hospitals (I think they are probably required to by law). Any other Dr visit needs to be at a Kaiser though and it is def to your benefit to try to make it to a Kaiser even for the ER if you can.
- laurencerowe 7y agoMy experience has been fine with Kaiser for an out of network ER visit, I just got charged the standard copay. CA law seems to specifically protect those of us on HMO plans: https://www.sfchronicle.com/bayarea/heatherknight/article/SF-General-s-insured-patients-suffer-further-13543542.php https://www.sfchronicle.com/bayarea/heatherknight/article/SF... """ Under state law, the practice of “balance billing” — sending a bill to a patient if his or her insurance company doesn’t pay the full requested amount — is illegal for people insured through a health maintenance organization. Kaiser is an example of an HMO, a network of doctors that supplies services to its members. """
- ianmcgowan 7y agoMy wife had an emergency, which ended up with removing one of her ovaries. Kaiser was pretty insistent about transferring her from the closest ER to one of their facilities (which was stressful), but after that the treatment was awesome. After a some major surgery and a few days recovering the bill was completely covered. Kaiser isn't perfect, but they're the closest thing to a reasonable health-care system I've seen in the US. Agree that there are worse models for how to do healthcare, within some of the constraints of the US system.
- AnimalMuppet 7y agoYou know, I've recently seen here on HN complaints about "product substitution" at Amazon - getting, not what you ordered, but something that Amazon thinks is equivalent. I'm not sure medical supplies is where you want that to happen. I'm therefore not sure that the comparison of price to Amazon is fair. Note well: Yes, hospitals also gouge you. I am not claiming otherwise.
- kjksf 7y agoClearly they used Amazon as a proxy for "place you can buy it". The important part is being over-charged 900% over retail price, not the exact retailer you buy it from. Also, it's a sling, not an anti-HIV drug. Hardly a "medical supply".
- chachachoney 7y agoRegulations criminalizing "product substitution" for healthcare products and foods are also in order.
- georgeburdell 7y agoSo I work in manufacturing. On one of our systems, we recently upgraded the fleet to a $10k computer with a 22nm processor running RHEL 7 supplied by the system vendor. We had all of the install files and could have bought a $2k computer and gone through an extended install and qualification process, and closing the door to some support from our vendor, but we didn’t. We paid the extra $8k for a guarantee that it would just work and that we could get the exact same computer for years to come. I see these high prices for what appear to be commodity items in a similar light. You are paying for a certain amount of comfort that the sling will just work. Amazon is not going to care if the sling, which might be a cheap knock-off, rips apart while you’re walking and unseats your unhealed bone.
- mdorazio 7y agoHere's where that analogy falls apart: If your 10K computer fails, your vendor will fix it under the support contract for free. If the hospital-provided sling falls apart and you go back to the hospital, they'll charge you again. In most cases, the product is the same one you can get yourself elsewhere, and it still doesn't come with a guarantee.
- kube-system 7y agoWhile that is absolutely true, there is a level of confidence in knowing that the one from a hospital was sourced from a legitimate supplier and that it likely meets some level of quality control standards, legal standards, and supply chain controls. But this is more of a criticism of Amazon than anything, as those things would be true for a drugstore as much as it would be for a hospital.
- mdorazio 7y agoAgree on that - things sourced from Amazon are increasingly likely to be suspect quality these days.
- UncleChis 7y agoI think you missed the point that we need an open pricing system. Sure you are willing to pay $200 for that sling but others might decide differently if they see the price beforehand!
- 14 7y agoI live in Canada. I have visited the ER probably 5 times in the last year with different kid ailments. I pay MSP about 30$ a month CAD and that covers me and my kids. I do pay out of pocket for medications but any visits to the doctor or hospital are completely covered. Work benefits covers 80% of the meds I have to pay out of pocket. I don't have to second guess when to go in I just go in when things get bad, no questioning will this visit leave me financially unable to feed my family and take care of my health in other ways. I just go in. I hope you guys get something better working for you.
- mrtweetyhack 7y agoWhen you have insurance, everything is more expensive
- jmugan 7y agoSome states have price gouging laws to keep people from being taken advantage of when they are in a vulnerable state, you can't charge $30 for a gallon of gas after a hurricane, I don't understand why hospitals are any different.
- sjg007 7y agoThat'd be a good argument to try. It would probably work.
- awb 7y agoJust to pile on about how ridiculous medical costs are: After giving birth my wife was offered Ibuprofen. On the bill we were charged $80 for the 2 pills she took. This was before Obamacare. After Obamacare I twisted my ankle and the doctors insisted I wear a cheap fabric boot with stiff plastic plates while it healed over the next couple weeks. I asked how much it cost and they said $280. I took it off and refused it while they gave me dirty looks. A medical facility is basically a monopoly. The switching costs are high and there are no prices on anything. Unfortunately getting everyone insurance was only the tip of the iceberg of the actual problem. We still have a long, long way to go before we have real, competitive medical pricing with high quality care.
- djsumdog 7y agoThe ACA was a blatant failure in most states. It's still not affordable and large groups of people were never insured. ACA approved plans proved to be bogus. I wrote about this once before: https://fightthefuture.org/article/returning-to-america-and-the-unaffordable-care-act/ https://fightthefuture.org/article/returning-to-america-and-...
- vernie 7y agoIt was a wrap for the ACA when Lieberman used all his remaining Joementum to kill the public option.
- lotsofpulp 7y agoACA plans on healthcare.gov are only too costly because employers were allowed to keep their grandfathered plans silo-ing healthy lives in low cost plans to benefit big white collar businesses. This had to be done to appease the Republicans who need to “cross the aisle” and vote for it (and Lieberman who was basically a Republican too). If everyone was forced onto healthcare.gov, there would be enough healthy lives to offset costs from sick lives to create an effective market.
- chooseaname 7y agoIt isn't just about getting everyone insurance. It's about fixing the whole process. My Dr ordered some not too expensive tests for me. My insurance refused. I was like, wait, what? You're overriding my Dr? It's insane.
- cosmodisk 7y agoReading this in Europe.I'm sure if I'd go with article alone to my American colleague on Monday, he'd defent the system even if he'd have to die for it. Knowing he's a healthy 20something man with affluent parents that could potentially bankroll even a year's stay in a private hospital- I could understand it to certain degree, however I fail to understand why nobody really is up for changing this system,where millions upon millions left woth no choice but to struggle anything but basic medical care.
- danans 7y ago> however I fail to understand why nobody really is up for changing this system,where millions upon millions left woth no choice but to struggle anything but basic medical care. Plenty of people are up for changing it. It is quite literally the center of a huge debate at the moment in the Democratic primary, and there is a broad spectrum of changes being proposed, from Medicare for all with price controls to a slightly modified Obamacare. Only one candidate among those more or less supports the status-quo. And the Republican party is currently avoiding discussing the way they'd like to change the health system (repealing Obamacare, fee for service care) because it isn't particularly popular at the moment. Meanwhile, stories like the ones you see piling up in this thread happen every day.
- cpursley 7y ago> And the Republican party is currently avoiding discussing Are you so sure about that? A republican president recently signed an executive order for more transparent pricing: https://www.npr.org/sections/health-shots/2019/06/24/735578519/trumps-plan-to-lower-your-hospital-costs-heres-what-you-need-to-know https://www.npr.org/sections/health-shots/2019/06/24/7355785...
- deleted 7y ago[deleted]
- danans 7y agoThe centerpiece of their plan is removing the protections provided by Obamacare, like pre-existing conditions coverage, the state insurance exchanges, and getting rid of the Medicaid expansion. They don't want to talk about any of that right now, even though it was the central refrain of what they ran on 4 years ago. But that's smart actually. They correctly realize that it is political suicide to run on taking health protections away from people at this time.
- tryitnow 7y agoI went to the ER last year. They ended up making me stay overnight. I was hit with a bill for over $10K, with much of that falling on me. I also used to work in corporate finance and I have a good intuition for how billing works. Before I even got the bill I mentally prepared myself for it by telling myself that it's going to be a long drawn out process. I waited and waited and received an initial bill a few months after my hospitalization. It was for the aforementioned amount. I called and politely asked to have it itemized. Naturally,that took several more months. The bill was reduced, but the itemization was incorrect, so I asked for a correct itemization. I went through a few more iterations of this. Each time the bill got lower and lower. Eventually, I had to pay something like $1.5K out of pocket, which would have been a lot less if I didn't have an HSA. The whole process took almost a year. If you ever have to go to the hospital, just assume that it will take forever and nitpick the bill (within reason) and continue to challenge it. They will often give up and reduce your bill. Whatever you do, never pay a bill that is not itemized. As a former finance professional I am shocked that hospitals can get away with this, this would never fly in the B2B world, professionals always push back against "mystery bills" that show just the bottom line number.
- mwambua 7y agoWhat do you mean when you say the itemization was incorrect? Do you mean that the prices that they list were incorrect, or that the items didn't make sense given the treatment you received? In either case, what reference do you use to ascertain correctness? I feel like information asymmetry is a problem for a lot of patients. It's hard to tell if you actually need a treatment, or if you're being charged fairly for it.
- brycehamrick 7y agoUpcoding is extremely common and almost never comes with any consequences. It's routine for staff at the hospital to add line items for things that never actually happened. I've personally seen procedure codes for neuropsychological testing in the ER when the staff never completed those exams, as an example. The billing codes require very specific actions to have taken place in order for the insurance companies to reimburse. It's not often done out of malice, the codes added are likely what should have taken place but the hospital staff are overworked and end up cutting corners.
- yalogin 7y agoThe whole ecosystem has evolved to loot people when they are at their most vulnerable moment. There is no two ways about it. It goes unchecked because insurance companies cover a bulk of the cost and so most ordinary people don't see it. The poor and uninsured get the bad end of the stick but no one cares about them. Just a pathetic state of affairs.
- danans 7y agoI have very good insurance by US standards through my FAANG employer. My son recently got a full body reaction to poison oak exposure. No hospitalization, just a couple dermatologist visits, 30 minutes each. After insurance paid its portion, I got a bill for $800 in out-of-pocket charges.
- refurb 7y agoHow much of that was your deductible? Generally really good insurance has a 10% co-insurance charge. But the first $X amount is entirely borne by you.
- yumraj 7y agoThis is identical to what had happened in my case, the patient was my son who had fractured his arm. Had taken him to Stanford Emergency, he got a a cast and a really cheap sling. Received a bill from a Texas based company, don't remember the name, for about $200-$300, for the sling. Looked online, there were bunch of BBB reviews about this, including about calling them where the issue was settled. Same sling on Alibaba.com was $1-$2. I called them up. I was told we were out-of-network for the sling, even though Stanford hospital was in-network. However, since we were in CA, we are kinda protected if we don't know this (in/out of network) in an emergency room. I had the option of asking Stanford and insurance company to refile, or pay them $20 (from original invoice of $200-$300). I paid them $20 to settle the claim.
- dhdudxbeub 7y agoWhen my wife was 25 weeks pregnant she started feeling ill and we noticed her blood pressure kept going up. We went to the hospital. Turns out she was pretty sick she so they made her stay for 4 days. A few weeks later we had our son’s ashes and a $148,000 bill.
- tehlike 7y agoAdding insult to the injury. Im sorry for your loss... We lost our first, and er visit costed us much less. Few thousands... Didnt have the energy to fight that time...
- dhdudxbeub 7y ago:( sorry - it sucks We had insurance so we didn’t pay that crazy amount but it’s just absurd what these places charge.
- tehlike 7y agoI was assuming that. Even still, 148k bill, and an unimaginable situation is still a shocker. I am willing to fight, even though my out of pocket is also very small.
- FireBeyond 7y agoI'm very sorry for your loss. This is the only country in the world where there are people who will divorce on their hospital death bed, because they are so fearful of the financial impact on their remaining family. And a non-insignificant part of the population finds this acceptable because they see the alternative as "the government treading on me".
- rahuldottech 7y agoI'm so, so sorry for your loss.
- janesvilleseo 7y agoI’m sure going to get downvoted for this but.... I just don’t pay my medical bills I pay my dentist and eye doctor bills since those are different. But I just let my insurance pay their part and I walk away from the rest. I haven’t had anything catastrophic yet. But have and do have bills in the 1,000s. My credit score is great in the 740+ range. I know big stuff they could take me to court or put a lien on my property. They haven’t yet. It’s my little protest against all of this crazy healthcare prices and system we have here in the US.
- joe5150 7y agoI tried to make payments to the hospital on a few thousand in bills, fell behind, and eventually got sued. I would not offer this as advice to anybody. If somebody from the hospital had told me _before_ I got served that I could get 85% of my bill written off just by submitting some paystubs, I would have appreciated it. If you're in a similar spot, call and ask about patient financial assistance or similar programs.
- RandomBacon 7y agoDo you go to a different dentist and eye doctor each time? Also, if you had to go to an emergency room, would you give them fake personal info so they can't send you bills?
- joe5150 7y agoYou can be several thousands in arrears (and even in collections) to the hospital and still visit the ER, see your doctor, get a CT scan etc. I know because I've been doing it since 2017, but I have insurance and the people I see probably just assume the bills are getting paid if I keep coming back. Care providers and admitting people don't generally access your financial/billing information.
- janesvilleseo 7y agoI pay my dentist and eye doctors. Those are treated differently. There really isn’t eye insurance and dentists usually have normalish prices compared to other doctors. I mean I can ask my dentist how much it’s going to be and he can actually give me a price before my procedure. But as I stated above the insurance pays their portion so it’s not like nothing is being paid. Just not the 900% markup. I don’t recommend doing this. I’m sure it will bite me eventually but it’s been 10+ years. And yes I haven’t had any major or catastrophic medical event in my life. So the bills haven’t been in the +10k range. I’m pretty sure once it gets there they will put a lien or sue me. I go the same facility every time. I haven’t been denied. My family hasn’t been denied. If I did go to an ER for something serious I would give them my real name and info. I do have insurance and it will pay a portion. Depending on the size I might pay it. I might not. Just haven’t had anything really large.
- arbuge 7y agoI was charged $50 for 2 tylenol when I had my appendix taken out. The CVS down the street would sell you a 24-pack for $5. Of course, that was just a minor component of the final $50,000 bill ($4k for me after insurance), but it still sticks out in my mind many years later because it was an easily comparable baseline. Health insurance companies get alot of the blame for the broken healthcare system in America but I place most of it on the providers - doctors, hospitals, and drug companies. They bill an order of magnitude too much. Sometimes more. Attacking doctors seems to be a much less politically palatable option than attacking big insurance corporations, even though those doctors are essentially gouging their loyal patients with no qualms about it.
- brandoncordell 7y agoThe hospital charged me $1,700 for 1.5mg of xanax during a 3-day stay. It's utterly ridiculous what they're allowed to get away with.
- lightgreen 7y agoThe hospital sling was $200 according to the article. Amazon sling is $12.99 to $16.99 according to the article. So hospital sling is 12-15 times more expensive. So I suspect that the original writer of the article correctly wrote that hospital sling is 10 times more expensive. Then the editor came and decided that 10 times more expensive looks not as scandalous as 900% more expensive. The result is false precision https://en.wikipedia.org/wiki/False_precision https://en.wikipedia.org/wiki/False_precision and bad journalism.
- jameshart 7y agoI have no idea what you're complaining about here. If they had taken the $12.99 price (an actual exact price, with 4 actual significant figures of precision), the $200 bill (also an actual price paid, with five significant figures of precision) is actually, really-not-false-precisely, 1440% more expensive than amazon. They allowed in the article that the sling might be a bit nicer than the ones on amazon - it had some padding. So they rounded its value up to roughly $20, giving, as you suggest, 10 times more expensive, as an estimated factor. Let's assume that's only good to one sig fig. That's fine for an estimate, and consistent with the 'probably worth a bit more than the ones on Amazon, let's say somewhere between $16 and $25' methodology. "900% more expensive" is a perfectly accurate restatement of "10 times as expensive" to a single significant figure. Would you rather they went with "1000% more expensive" to make it feel more Benford's-law-comliant in its imprecision? That would surely have helped your supposed sensationalist editor, right? "900% more expensive" is literally just another way of writing "ten times as expensive". So I really don't know what kind of editorial sensationalism conspiracy you are trying to posit here. Wouldn't a sensationalist have gone with the 1440%, and nefariously rounded it up to 1500% to punch up the headline? This seems like a weak place to try to hang an argument about the innumeracy of the press....
- lightgreen 7y ago> "900% more expensive" is literally just another way of writing "ten times as expensive". No, it is not. Same way as "ten times more expensive" is not the same as "10.000000 times more expensive". Using percentages here implies high precision. > Would you rather they went with "1000% more expensive" "10 times more expensive" sound just right. > I really don't know what kind of editorial sensationalism conspiracy you are trying to posit here. Sorry, no sensation here. Just false precision which is a bad sign.
- golover721 7y agoAnother thing that bugs me in the whole "medical cost" disaster that is the USA. Whenever you talk to Doctors or other medical practitioners about the situation they blame the hospitals, or the insurance companies or <fill in the blank here> but ultimately they are complicit in the mess, but they don't want to rock the boat, its just shameful.
- chillacy 7y agoThe whole system of massive school debt and massive salaries for doctors resting on the AMA artificially limiting the supply and scope of doctors? Yea I'd say so.
- Paul-ish 7y ago> AMA artificially limiting the supply and scope of doctors? I see people say this, but what does this mean? Should we not certify our doctors? Should just about anyone be able to hang out their shingle?
- tlb 7y agoYou could increase the supply of doctors without impacting quality, by training more doctors. Medical schools are the main bottleneck, and their sizes are regulated by the AMA to constrain supply.
- lotsofpulp 7y agoSchools are not the bottleneck, residency spots are the bottleneck. Residency spots are governed by the federal government (Congress) and someone, somewhere must be lobbying to keep the number of spots low. https://www.huffpost.com/entry/who-pays-for-resident-sal_b_12967008 https://www.huffpost.com/entry/who-pays-for-resident-sal_b_1...
- chillacy 7y agoThere are options between "free for all" and "highly restricted to the point of public harm". Another thing would be to expand the scope of nurse practitioners where it makes sense.
- blhack 7y agoHas anyone here ever worked in this industry? I'm curious what the justification for these prices is? I can't imagine it is quite the scrooge mcduck caricature where the people reaping these profits are literally trying to defraud people. I would love to talk to a health insurance insider or something and ask them to justify this stuff.
- chooseaname 7y agoTwo guesses: 1) return money to investors at all costs. 2) inability of us to get any sort of Tort reform going in this country.
- war1025 7y agoMy mom worked in medical records at a small hospital. The way she explained it to me was that insurance companies negotiate prices way down, and expect to. So in order to make enough money to cover costs, the hospital has to put astronomical sticker prices on everything so that insurance can "talk them down" to the actual price they expect to receive. Mostly our healthcare system is completely fucked and we should all feel bad.
- noelsusman 7y agoI've spent my whole career working for hospitals primarily dealing with cost data. There's not much incentive to create a sensible pricing structure because very few patients actually pay the posted prices. Most revenue comes from the government or insurers, and neither of them give a fuck what you charge for a sling. Hospitals have limited resources, and dealing with insurers is a big enough operation as it is. Most chargemasters are created by multiplying acquisition cost or Medicare rates by some absurd number (typically 8-10) and calling it a day. Frankly, I see this whole thing as a red herring. I get why people get upset about it, but if you ended this practice then the money would just shift somewhere else. Hospitals are mostly non-profits with small margins, so the money has to come from somewhere. Instead of charging 10 times cost for everything they would just dump it all into a generic fee. This kind of stuff isn't actually relevant to the core problem of why healthcare is so expensive in the US. It's definitely not a scrooge mcduck caricature situation. Like I said, most hospitals are non-profits who post their financial statements online. You can probably go look at your local hospital's statements to see what kind of margins they're working with. There are exceptions, but I'd bet they're pretty low.
- eblanshey 7y agoIf healthcare costs are so astronomically high, why are so many Americans supportive of mandatory insurance that forces insurance companies to pay those prices? It sounds as bizarre. It's like if a normal pair of shoes cost $1000, and people decided shoes are a right and everyone should subsidize each other's $1000 shoes. How about fixing the root problem first: a pair of regular shoes shouldn't cost a thousand dollars! Find the laws that enable this to happen (patent, IP laws, etc) and change them! Forcing everyone to pay those prices seems to mainly benefit the very people charging those ridiculous prices and enables it to continue.
- mjevans 7y agoAmerican's hear a word like "socialism" and think that it's a lack of competition and thus innovation. They don't think of it as a regulatory floor to a market. A standard of service to surpass (if even possible). The correct way to sell this to the populace is probably by framing it as a "minimum standard of service for all", and "getting the full value out of your taxes".
- jorblumesea 7y agoAmerican's are brainwashed to vote against their interests because there's significant money to be made. The healthcare lobby spends enormous sums lobbying (bribing) politicians, influencing debates, changing public opinion and killing legislation.
- stjohnswarts 7y agoA lot of rural areas tend to vote for their party rather than for what makes sense.
- exabrial 7y agoYes it's called lack of competition. It's hard to blame them when you face jail time for offering an alternative
- isostatic 7y agoI live in the UK. My father had a stroke a couple of days ago. He’s in intensive care on a ventilator. Total bill so far: £2 parking. Also the coffee machine in the relatives waiting room was out of sugar.
- ianmcgowan 7y agoI'm from the UK, but live in the SF Bay Area, and this is the single biggest thing I don't get about the US (with education costs being second). I kind of get the libertarian view of not wanting to trust the government but when the alternative is some kind of Mad Max dystopian hellscape (where people are literally dying), surely looking around the world for alternatives that actually work makes sense?
- sarcasmOrTears 7y agoIt's not libertarian. The US system is cronyism, statism at its finest, possibly illegal. Honestly, I think with current US laws and a willing political force, a lot of top players in the current US healthcare system could be punished, even with the death penalty (especially if reinstated at the federal level). Dreams aside, in order to have a free market healthcare, which is what informed libertarians want, you need to abolish medical license, the FDA, patents and many other State's interventions. There is a reason why the healthcare system in the US is insane, and it's because the laws are made so that cronies have the monopoly on your health. Neocons are pathetic when they defend the current system. Without the free market (the real one, not the scam you have in the US), healthcare will be a mess more than any other industry and at that point is better to have a single payer, universal system, because in the end they have the same problems of the current US system but at least you don't get ruined.
- lotsofpulp 7y agoA functioning market is one where multiple market participants exist (both buyers and sellers) and both are able to make educated choices. How can a market like this exist when the buyer is incapacitated, not to mention even when not incapacitated, the buyer is not sufficiently educated to understand what they are buying?
- sangd 7y agoIt's not the hospital alone. I went to my Kaiser optometry for my wife's glasses yesterday, and they said it would cost $375 for her pair. Her insurance would cover $175 + $100 discount, and the rest she has to pay. She has a Platinum coverage with Kaiser. We went home and she ordered 5 pairs online for $50. The anti-reflective coating cost $90 at Kaiser, but only $6 online. Fortunately, I don't wear glasses.
- ianmcgowan 7y agoKaiser is actually the best/most European option, if it's available to you. This exact thing happened in my family, but the lesson I took away is being grateful to Kaiser for letting us know the price ahead of time, and all but forcing us to go a different (much cheaper) route for my wife's glasses. Don't hate the player, hate the game, and all that...
- tehlike 7y agoEye care is mostly a monopoly where luxotica owns the market. Warby parker, zenni, etc are the disruptors.
- DoofusOfDeath 7y agoApologies for being a little off-topic, but what online vendors did you use? Asking because I have the very same issue in New England.
- blackflame7000 7y agoThe insurance wouldn't be so much of a problem if things like saline solution didn't cost $595 (personal experience)
- KboPAacDA3 7y agoWould this change if the government paid 100% of the bill?
- thayne 7y agoI don't understand the arguments that private health care is better because of competition. What competition? I can't comparison shop for health insurance, if I don't use what my employer chooses I have to pay thousands of dollars more in premiums for an even worse plan. And then I am limited in the providers available by the network. Not to mention that comparing prices is impossible when you don't know the price until months after you receive the service.
- novalis78 7y agoThe sling for $400 is what triggered my personal ‘down the rabbit hole’ of the in-transparent hospital cartel system. pricepain.com was one outcome.
- kbutler 7y agoMy son had a minor in & out surgery earlier this year. Could have done it in the office, but the doctor recommended a surgical center that was out of my insurance network. "Our patients have been very happy with the price." I called the surgical center, and was told it was a flat fee of $500, payable in advance, for which I received a receipt: "Facility fee". We did the surgery. The doctor's bill was well under a thousand dollars. Almost six months later, the surgical center sent a bill to my insurance for $48,000 as a half-dozen line items, each listed as "facility fee". My insurance says they paid $25,000 and the patient responsibility of about $10,000. We haven't seen a bill from the surgical center, and I told the insurance it was either a billing error or fraud, as it was 100x the price I was quoted and accepted up-front.
- HorizonXP 7y agoI realize that this article and the HN comments are centred on the US, but here's a link to the Schedule of Benefits (i.e. the costs) for all insured services that are compensated for by the Ontario Health Insurance Plan (OHIP): http://www.health.gov.on.ca/en/pro/programs/ohip/sob/ http://www.health.gov.on.ca/en/pro/programs/ohip/sob/ Meaning, while most Canadians do not know what our healthcare actually costs, it's all itemized, standardized, and freely available. I just looked it up and was surprised to see that C-sections are only about $80 more than vaginal delivery (we just had a kid), so it's nice to know that there isn't much incentive for doctors to push one over the other. I realize that's a gross oversimplification, since there's probably a lot of other billing codes that get tacked for surgeries.
- metaphor 7y agoThanks for the reference. I'm not Canadian, but it was very enlightening to browse through and surprisingly well organized.
- nextstep 7y agoMedicare for All! Please fix this, America
- habosa 7y agoMy girlfriend fell skiing and tore her ACL. We were taken down to the mountainside clinic. They were just gonna do a basic check and give her some Advil and a brace. I asked how much it would cost. They said they were not ALLOWED to tell me. Which is different than not knowing. I told them what insurance I had. They said many people came in with that insurance. I asked how much of the procedure is normally covered. Also apparently a secret. I just can't see how it's legal to bill someone for services received while refusing to give information on what it will cost. If the bill had been $50k what recourse would I have had?
- nojvek 7y agoWhat are you gonna do? You’re injured. Gonna go somewhere else? Everywhere it’s the same. The greatest scam of our time.
- mgkimsal 7y agosemi-seriously wondering if you could claim your sincerely held religious beliefs prevented you from entering a binding contract without knowing the terms/cost of such a contract. would your religious beliefs trump their position?
- ck425 7y agoShit like this makes me incredibly grateful for the NHS. It's one of the best things about the uk and I'm incredibly proud to be joining it next month.
- iamgopal 7y agoWhy medical tourism not a big thing ? All incidents mention could be cure in India at nice competent hospitals at fraction of this bill including air travel. What is the biggest problem in this space ?
- Pfhreak 7y agoTrust. People here are conditioned to not trust socialized medicine or medicine from less wealthy countries.
- paulcole 7y agoFirst sentence of the article: > Cathy Birker-Hake tripped over a hose in her Valley Village backyard not long ago, dislocated her shoulder and made a beeline for the emergency room. Nobody’s hopping on a plane to India with a dislocated shoulder.
- leesec 7y agoYeah I would imagine because most trips to the hospital aren't planned. I'm not flying to India or anywhere if I have a fever/flu and just need to get looked at. I would definitely fly somewhere for a planned surgery.
- ttul 7y agoMy son broke his femur at school. He was transported to hospital where he underwent surgery to insert rods. He stayed for four nights in a state of the art, brand new children’s hospital, brimming with wireless tech. The nursing care was top notch. I had to pay for parking. Once he was back at school, the school district brought out occupational therapists who assessed his new disability and provided extra assistance while he was wheeling around. He has had four follow-up visits with the orthopedic specialist. In a month or two he will have another surgery to have the rods removed. I will then have to pay for parking again. Welcome to Canada.
- Bootwizard 7y agoIs the parking $20,000?
- dredmorbius 7y agoCanadian. So, about $2.50 US ;-)
- dwild 7y agoThe parking is actually quite expensive, when my stepmom had cancer, I went a few time with a car and it was 16$ per day. That hospital made 60 millions in parking fees in 2015 as a reference... That was the time I understood how lucky we are, when the final diagnostic fell, it was the first thing that came to my mind, what would have they done if it wasn't free... they would have to decide whether they try to give her a few more years and pay hundred thousands, or just watch her suffer a few more months. Sadly even with the amazing care she got, she died less than a year later, but at least they got that time and they never had to worry about the cost of it.
- drtillberg 7y agoDoes anyone else find this business arrangement between the DME provider and the hospital to be fishy? > they dispense the product on Breg’s behalf and Breg follows up with its own bill. My intuition tells me that this relationship may have generated a little side hustle for the hospital, which if it really occurred would be extremely illegal. That reporter should dig a little more.
- pxeboot 7y agoHas anybody ever hired a high powered attorney to challenge medical billing in the US? This feels like something one or two successful lawsuits could change really quickly. Hospitals seem to have done an amazing job of charging just enough after insurance for the upper/middle class to be willing to pay to avoid hurting their credit scores, but so much that everybody else just doesn't pay and files for bankruptcy if anybody ever comes after them.
- sabujp 7y agoibuprofen also costs $80 a pill at a hospital ..this was 7 years ago, no idea what it costs now!
- sparrish 7y agoReminds me of the brief hospital visit I had in Paraguay where I needed to have a friend or relative always with me because the hospital didn't stock anything. If ibuprofen, bandages, syringes, antibiotics, etc were needed, the hospital staff would tell me and I would have my friend or relative run across the street to buy the necessary supplies from one of the pharmacies so the doctor or nurse could treat me. Cheap hospital bill, cheap pharmacy bill, pain in the butt for my friends and relatives.
- etairaz 7y agoSuch a long article, and the reporter never bothered to talk to a doctor and get reassurance that indeed the hefty price of the sling is unjustified. This isn't journalism, it's gossip. Sling may or may not be overpriced. Amazingly, you can't tell from this 1000 worder
- deleted 7y ago[deleted]
- dmh2000 7y agoWhere does she get insurance for 1500 annually? 'And that doesn’t include the nearly $1,500 she pays in annual insurance premiums.'
- alluro2 7y agoWriting this from basically a 3rd world country, Serbia, which you might have heard of in context of a series of armed conflicts, civil wars and highly corrupt governments (current one being orders of magnitude worse)...Even after all that, and civil infrastructure and industry having been bombed back 50 years into the past (by NATO), we still have free high quality education and free healthcare...Those are simply the basic functions of a society - a lot can not function and be in a bad shape, but if you don't have these - what do you have from a government? How the US managed to get it perverted to this extent, is beyond me...
- socialist_coder 7y agoIs any organized collective action from the public possible here? What if we had a service that would take your itemized bill and spit out the fair market prices. Then, you would tell the hospital/doctor/insurance that you would pay this price and nothing more. If enough people did that, could it actually work?
- chanon 7y agoI live in a developing country ... Thailand. Reading things like this, stories in this thread, and about how people are avoiding seeing the doctor because they're afraid of the bills ... makes me realize in some ways Thai people actually have a higher quality of life than many in US in this respect. Costs are order of magnitude(s) lower. A night in the hospital is typically 5,000-10,000 baht or $166-$333. And the quality of care is at a good standard .. so much so that Thailand has become a Medical Tourism destination: https://www.health-tourism.com/thailand-medical-tourism/ https://www.health-tourism.com/thailand-medical-tourism/ If you have some money, you can pay more for faster service and more attentive care at more expensive private hospitals. And if you can't pay, you are still covered by Thailand's Universal Healthcare: "What Thailand can teach the world about universal healthcare" https://www.theguardian.com/health-revolution/2016/may/24/thailand-universal-healthcare-ucs-patients-government-political https://www.theguardian.com/health-revolution/2016/may/24/th... "Thailand: At the forefront of Universal Health Coverage" https://medium.com/health-for-all/thailand-at-the-forefront-of-universal-health-coverage-d1bb9c0c3e79 https://medium.com/health-for-all/thailand-at-the-forefront-... Thailand is a relatively poor country, but we are still able to do this. In the US, I guess some people would rather die than admit needing help from the government ... or trying to clamp down on healthcare costs cause it would be too much 'regulation'?
- m101 7y agoSounds like people should take some time off work and fly to Thailand for treatment. Any reason why there isn't more medical tourism? They do this in the UK for getting dental treatment in Eastern Europe where fillings can cost €20 each.
- javajosh 7y agoWell, one reason people don't become medical tourists are concerns about quality. Americans in particular are still convinced, despite ample evidence to the contrary, that our medical system is the highest quality in the world - and that this justifies the costs. I believe this is false. Healthcare quality is basically the same in all first-world countries, the only difference is cost structure. (My wife had a c-section in Germany and our total cost was about 100 euros for an optional private room.)
- lightedman 7y agoYou think $200 for a piece of cloth is bad? Lil 8mm screw in my leg. I got a bunch. $800 each. TLSO brace, $4,000. Literally a modified dirtbike chest and back plate. The medical system is entirely broken. Ditto the insurance system.
- jmpman 7y agoWhat does the same medical equipment cost in countries with nationalized health care?
- agumonkey 7y agoI asked MDs about that, beside the normal certification fees there's also market dynamics at play. They know they can raise prices because hospitals and doctors can spend more.
- robomartin 7y agoThe cost of medical equipment in the US often has very little to do with the BOM costs (Bill of Materials, the cost of the parts required to manufacture the product). Medical equipment providers have massive and onerous regulatory burdens on top of certification requirements. Even a relatively simple product an cost tens of millions of dollars to bring to market after design and engineering is completely done. This is one of the key problems with the US healthcare system and why talk of this or that insurance scheme (regardless of content) is absolutely ridiculous. To use a parallel, it's like talking about selling a $10 burger for less without changing the underlying cost structure that causes a burger to have to be sold for $10. Anyone who proposes a "new and improved" insurance scheme betrays an utter lack of understanding of the most fundamental of concepts: If you don't do a thing about baseline costs there is no insurance-based solution that can ever "fix" the problem. This means taking a very hard look at the cost (in time and money) of the regulatory burden as well as the other element of that cost structure: Tort reform. Both of those factors increase the cost of absolutely everything even remotely related to the medical industry. Fix that first and then medical insurance will magically become cheaper and better.
- WA 7y agoAs a German, this whole thread reads entirely bizarre. The US health system is the blind spot of the nation. The kind of fuckery you people have to endure every day and the kind of thought processes it requires, is astonishing. As a German, you don’t have to spend any brain cycles on health insurance or medical costs. If you’re self-employed, you maybe need to think about getting private insurance. Besides that: health care is just there for you. You don’t have to pay almost anything from your own pocket (besides glasses and some depending on the age). The financial aspects usually can’t ruin you. Prices are "normal". I had a US friend over a while back. She had a tooth ache. The dentist fixed it and the bill was like 180 bucks or so. She couldn’t believe how cheap it was compared to the US. And this wasn’t some shitty job with inferior materials or whatever.
- agumonkey 7y agoSame goes for education, I remember the awkward silence when I told to a NY girl that tuition fees for public college in France was around 500eur/year. Of course taxes are different.
- mgkimsal 7y agoand I bet it's all completely untied from 'employment', right? this is the other huge blindspot we have here (US) - we've got generations of people who all have some odd belief this is somehow morally 'better' than employers provide this (because... that means you're 'working' and you need to be 'working' for the right/ability to have access to medical care).
- stjohnswarts 7y agoWhy is insurance tied to "employers" in Germany? That seems antithetical to the "healthcare for all" that I keep hearing about Germany and other European countries. Why would a private contractor be on their own for health care? Taxes? I mean even as a contractor I still have to pay taxes like everyone else.
- kartayyar 7y agoI went to a travel medicine clinic, and got two shots. The cost for the shots was ~200$, and ~300$ for consultation, which was a PA giving me printouts about information of what diseases are found in which countries. What a scam.
- Keverw 7y agoInteresting. I know some places require yellow fever but think that’s the only one commonly required. Seems common for South America. I think a world cruise be fun if ever rich enough so sounds like would need to get it. Personally not a fan of vaccines for multiple reasons, but I got a feeling at some places if you just wanted only what was required they’d try to convince or guilt you into getting the others. Maybe though if knowing you are going to go on a trip where you need it, get it elsewhere... say you go vacation in Europe, probably cheap enough to self pay even without being covered by their insurance. Plus the ingredients can vary by country too. I guess the one approved for Canada and the one approved for the US are different yellow fever wise.
- mexicanandre 7y agoAustralian here. We just had a baby. Emergency c-section - 5 night hospital stay, Amazing care. Amazing team and happy healthy wife and baby Total cost? $0 Yep we do it well