9 ms·

High medical bill in the ER leaves family reeling

56 points by grammarnazzzi 5y ago

whiddershins 5y ago
What’s confusing is hospitals aren’t all that profitable. So where does the money go? Is it going to treat people who end up not paying? Is it going to buy expensive diagnostic equipment? Where does it go? No one seems to know.
- mfer 5y ago
  A lot of it goes to inefficiency. Think of it this way. If you have a factory that makes 1 thing it can optimize around that. It can become cost effective. If you have a factory that can manufacture 10 different things, it becomes less cost effective because you need to be able to switch between the different things. If a factory can produce 100 different things it's even less efficient. Hospitals deal with thousands of things. Their overhead and complexity are high. This leads to inefficiency which costs more. I've read that the math around the costs map fairly well to the cost models around factories [1]. [1] https://www.amazon.com/Innovators-Prescription-Disruptive-Solution-Health/dp/1259860868/ https://www.amazon.com/Innovators-Prescription-Disruptive-So...
- seanmcdirmid 5y ago
  Non profits aren’t exactly virtuous or efficient with money. In fact, there are so many players involved in operating and running a hospital who want to get paid the fact that the overall hospital itself is a non profit isn’t very meaningful.
- fallingknife 5y ago
  Pure inefficiency. The medical industrial complex is second only to the government in its byzantine bureaucracy. This is why we will never be rid of it. All those hundreds of billions of dollars wasted are mainly going to pay millions of middle class administrative salaries. I know 2 people whose companies would not even exist in a socialized health system. Woe to whatever politician tries to pass a bill that will put millions of middle class Americans out of work.
- tyronehed 5y ago
- brummm 5y ago
  Also crazy large doctor salaries. The US pays way more to doctors than for example many European countries.
- at_a_remove 5y ago
  I have come to not view a given hospital as an entity. Rather, a hospital is a place (not just in spacetime, but in regulation, and in "the market") where numerous agents are at work in an opaque manner. Some are frantically billing anything that moves. Other agents are losing money on patients who will not or cannot pay and are looking for ways to balance those books so that they can continue to survive (consider the hospitals closing along the border as the "undocumented" end up in the ER). You have ambulance services struggling as people "cleverly" use them as taxis. Pharma slithers in and out, hoping to recoup their costs on nineteen failing drugs with wild sales of the twentieth. All of this occurs in the hospital "zone," and what patients see is a series of bills emitted, like push notifications out of an API. Making all of this predictable, transparent, and detangled is only step one. Hitting people -- actual humans -- with fraud charges is also a grand idea.
- grammarnazzzi 5y ago
  You can do wonders with accounting when you have control and collusion with your vertical markets.
grammarnazzzi 5y ago
> Hospital officials defend these fees as necessary to keep an emergency room open 24 hours a day as a community asset. What nonsense. This argument is effectively charging a rent without the consent or agreement of the renter (the community). If the service were reasonable, the community would agree to them. They are not, so the hostipital instead games the insurance system and preys on individuals without the resourses/ability to defend against their predation
- m-p-3 5y ago
  The fact that hospitals are privatized and not owned by the community is IMO the root of the problem.
  - Dwolb 5y ago
    Everyone has an opinion on the root of the problem but I’d like to see an actual analysis with the costs and revenues in our medical system to better understand what’s happening. Does anyone have a good one?
    - toomuchtodo 5y ago
      https://www.harvardmagazine.com/2020/05/feature-forum-costliest-health-care https://www.harvardmagazine.com/2020/05/feature-forum-costli... https://www.kff.org/health-costs/issue-brief/americans-challenges-with-health-care-costs/ https://www.kff.org/health-costs/issue-brief/americans-chall... https://insights.som.yale.edu/insights/why-is-healthcare-so-expensive https://insights.som.yale.edu/insights/why-is-healthcare-so-...
    - coliveira 5y ago
      Most countries have already figured out that the problem is privatized medicine and created universal health care systems.
    - fallingknife 5y ago
      https://www.mckinsey.com/~/media/mckinsey/dotcom/client_service/Healthcare%20Systems%20and%20Services/Health%20International/HI08_American_health.ashx https://www.mckinsey.com/~/media/mckinsey/dotcom/client_serv...
mfer 5y ago
The financials around US hospitals are something most don't understand. I didn't for a long time. For example, many procedures at a hospital lose the hospital money. They don't cover the cost. Other things cost more and make up the difference. Another element is that most US hospitals are very inefficient in what they do. In the book The innovator's prescription you can read the technical details on how those inefficiencies happen.
- duped 5y ago
  Healthcare isn't supposed to make money, it's supposed to stave off death. Just like schools aren't supposed to make money, or the postal service, or the military. Framing things in the context of whether or not critical services to society make or lose money puts it in a fundamentally unfair context. I don't want hospitals to make a profit, or generate revenue. Every procedure should be losing money.
  - refurb 5y ago
    How do you pay staff without revenue? Building maintenance? Garbage collection? Even communist systems had budgets and financial rules.
    - duped 5y ago
      - refurb 5y ago
        So use tax money to pay hospitals so they have revenue? That was entirely my point.
  - mfer 5y ago
    Hospitals need to break even on finances. What they take in needs to cover their costs. Anything other than this needs to be subsidized by an outside organization.
dfxm12 5y ago
1. Buy expensive health insurance to cover medical bills 2. Never use it because even though you have no idea what you're going to be charged, you know it is going to be outrageous, even though you have insurance to cover medical bills What a racket...
- Spivak 5y ago
  The only sane play in the US is 1. Buy an inexpensive high deductible insurance plan to cover only emergency expenses. 1.1. Make sure that for your plan out-of-network expenses count toward your oopm. (1.2. Cry because your employer's health plan doesn't work for this.) 1.3. Have enough cash liquid to cover your oopm. 2. Max out your HSA contributions. 3. Pay cash for everything. Sans 1.2. this has been working reasonably well for me. You would be amazed at the discounts you get once you say you're paying cash. Medical expenses suddenly are downright reasonably priced. tl;dr Surprise! Everything is cheaper when you have money. Oh America.
  - awinter-py 5y ago
    out of curiosity did you try to get your employer to cover your plan on a pretax basis? what happened?
  - LinuxBender 5y ago
    You would be amazed at the discounts you get once you say you're paying cash. Anecdotally I found this to be true with prescriptions. I didn't even ask for one but as soon as I told the pharmacist I was paying cash he said, "Oh, let me apply the coupon for you." and gave me a 20% discount. It was already a cheap generic but I wasn't going to complain.
    - lazyninja987 5y ago
  - toomuchtodo 5y ago
    You can short circuit this by working remotely for a US company from another country with a functioning healthcare system. If done properly (LCOL, excess income is invested), you mitigate not only healthcare system expense issues, but also can get towards a position of financial independence to mitigate the usual delays in finding your next role. For example, to have a child's broken arm evaluated and casted in a Mexico capital city is less than $100, total. Annual cost of living for a family of four is $25k-30k/US.
syki 5y ago
This what happens when a significant portion of society worships the “free market” and wants to avoid government running things. In the U.S. we have managed to fully monetize just about every aspect of life. Even something as mundane as pumping gas has been almost fully monetized by blaring ads. EDIT: I know the U.S. healthcare system isn’t a totally free market. We’ve designed a system that isn’t government run but has mandates like ERs having to see patients. Half the country labels anything that isn’t government run as free market and anything that is government run as communism. These are proxy words. If you want a healthcare system that isn’t government run but that has a semblance of “free market” in it but that also “treats” most people this is what you get. Well, it’s what our system has morphed into.
- mfer 5y ago
  Except, the people who have taken the time to study how the system works will tell you that's not the issue.
  - jwmhjwmh 5y ago
    Other people who have also taken time to study how the system works will tell you that it is the issue.
    - refurb 5y ago
      Considering government policy in the US is a big reason for the problems, blaming capitalism is kinda funny.
      - lucian1900 5y ago
        The US government is capitalist. It primarily operates to defend the profits of large corporations. Yes, under either Democrats or Republicans, although the industries each represent only partly overlap.
        syki 5y ago
swayvil 5y ago
- maxverse 5y ago
  I think this is satire?
  - swayvil 5y ago
    I am 100% serious
- ourmandave 5y ago
  Downvoters hate sarcasm. Don't they realize you've suffered enough watching Season 8 six times?
maxverse 5y ago
NPR has a series of these "Bill of the Month"[1] articles about surprise medical billing, and I am not exaggerating when I say they are the single most depressing, scary, disheartening thing I read on the internet. The patients in these stories seem well-intentioned and well-prepared. They double check that their doctors are in-network. They triple-check what charges they should expect. But there's always a gotcha. There's always some hidden, between-the-lines reason hospitals come up with to charge you, and insurance won't cover. In one story, the surgeon invited an out-of-network surgical assistant into the surgery, without notice. In another [2], the labor and delivery department was classified as an ER, for a completely routine delivery. When these charges are dismissed, it's always because NPR reached out for comment, and the hospital backs down, presumably because of the bad PR. The unpredictably and seemingly arbitrary nature of medical charges makes me feel... queasy. And scared to seek medical help, which I know is what insurance companies want. Even with great insurance, which I'm lucky to have, it feels like there's nothing I can do to prevent medium-to-insane charges. The only way I can think of to try and combat medical billing is to retain a lawyer. [1] https://www.npr.org/series/651784144/bill-of-the-month https://www.npr.org/series/651784144/bill-of-the-month [2] https://www.npr.org/sections/health-shots/2020/07/22/891909610/knee-repairs-use-of-surgical-assistant-leads-to-a-costly-surprise-bill https://www.npr.org/sections/health-shots/2020/07/22/8919096... [3] https://www.npr.org/sections/health-shots/2021/10/27/1049138668/childbirth-how-hospitals-inflate-bills https://www.npr.org/sections/health-shots/2021/10/27/1049138...
- maxverse 5y ago
  Emphasizing this from the article: > Martand received almost no medical service. A nurse practitioner looked over the toddler, listened to his heart and stomach, and looked in his nose, mouth and ears, according to provider notes prepared by the hospital and shared with KHN by Bhatt. > The nurse didn't change the dressing on the wound or order any testing. > Emergency visits are usually classified for billing on a scale from 1 to 5. Level 1 is minor and routine; Level 5 requires complex care for life-threatening conditions. [...] Despite the lack of severity of Martand's wound and the absence of medical care, his visit was classified as Level 3, a moderate severity problem. > In an email, Zoller Mueller said the charges were "appropriate" based on the "acuity of condition, discharge instructions, vital sign monitoring, traumatic wound care [and] numerous assessments." > She added: "A patient does not have to receive additional treatment — procedure, labs, x-rays, etc. — to validate an ED [emergency department] level charge."
irrational 5y ago
I’ve come to the realization that I’d rather die than leave my family having to pay huge medical debt. America’s healthcare system is completely broken (and I’m saying that as a child of a doctor from whom I learned how truly messed up it is).
- boring_twenties 5y ago
  No one has to pay your debts if you die (other than your own estate, of course). It's important, however, that your heirs understand this and don't say or do anything that can later be construed as having accepted the debt.
ProAm 5y ago
If they think $858.00 is a high medical bill in the US they are in for a surprise.
bazzert 5y ago
Running an ER is enormously expensive, who do they expect should pay for it ?
- yohannparis 5y ago
  Everyone! Roads, water, sewage are enormous expensive, but nobody cringe about subsiding them with taxes.
ahelwer 5y ago
I recently read a book on the history of socialized healthcare in Canada[0], which was fascinating. I'm very passionate about the development of a comparable system down here in the US but realized I didn't know anything about how such a program was established in countries where it actually exists! All I knew about Canada's case was that a dude named Tommy Douglas was involved (years later he was voted the Greatest Canadian[1]) but it's a bit more complicated than that. I had four main takeaways from the book: 1. Social programs can start regionally. There's a refrain you hear continually that if, say, California were to institute a socialized health insurance system it would immediately collapse because all the "takers" would move there (absent border control) to drain its resources. Yet that's how socialized health insurance developed in Canada - it was driven by the province of Saskatchewan, which had hospitalization insurance a full decade before any involvement by the federal government. To say that regional social programs are doomed to fail is simply against historical fact. This is how federalism is supposed to work! Experimentation is done at smaller scale and success bubbles up. 2. Doctors are the enemy. This was surprising to me, because I'm friends with a good number of (residency) doctors and all are very passionate about health equality. Maybe their opinions will change once that private practice money starts rolling in, I don't know. But basically organized medicine has opposed socialized health programs in every country they have been tried - an interesting counterexample to the idea that labor organization will per se lead to better social outcomes. 3. Liberals won't get it done (and might make things worse). This makes sense if you view it as a negotiation: socialists need to be pushing hard for radical change in order for the final product to land somewhere in the middle. If you're talking about the need for moderation at the beginning of negotiations, you've already lost. A good litmus test to tell whether someone is serious about healthcare reform or just making impotent gestures in its direction. 4. Socialized healthcare means more than free access to care. In retrospect this one is obvious, but I somehow had missed it. Just having access to healthcare doesn't actually make you healthy. The social determinants of health are much more powerful than going to the doctor once years of poverty have already taken their toll. The scope very quickly expands and you start talking about housing access, food access, and just economic equality generally. [0] https://arpbooks.org/product/radical-medicine/ https://arpbooks.org/product/radical-medicine/ [1] https://youtu.be/g4_v2701GMg https://youtu.be/g4_v2701GMg
- 5y ago
jimbob45 5y ago
The ER visit ultimately cost $38.92. The system worked out exactly as it should have. I'm getting a bit tired of these anti-US healthcare posts day after day. Sure, there are some issues, but this is starting to feel like reformist propaganda. I, for one, am very happy with the current system and don't understand why anti-government activists want to hand the government the keys to run the healthcare system.
- toomuchtodo 5y ago
  "66.5 percent of all bankruptcies were tied to medical issues —either because of high costs for care or time out of work. An estimated 530,000 families turn to bankruptcy each year." [1] The data is very clear Americans pay the most for healthcare out of every other OECD nation and yet receive worse outcomes [2]. [1] https://ajph.aphapublications.org/doi/10.2105/AJPH.2018.304901 https://ajph.aphapublications.org/doi/10.2105/AJPH.2018.3049... [2] https://www.pgpf.org/blog/2020/07/how-does-the-us-healthcare-system-compare-to-other-countries https://www.pgpf.org/blog/2020/07/how-does-the-us-healthcare...
- monkey_monkey 5y ago
  > and don't understand why anti-government activists want to hand the government the keys to run the healthcare system. Because it mostly leads to more efficient healthcare systems. For example, the per-capita healthcare cost in the UK is less than half that of the US for broadly similar outcomes.
- maxverse 5y ago
  > The ER visit ultimately cost $38.92. The ER visit ultimately cost $38.92, after: 1. He tried to negotiate the bill: "Dhaval Bhatt made numerous attempts to get the hospital to reduce the charges. He also appealed to UnitedHealthcare to review the charges." 2. The hospital refused: "His efforts failed....the hospital would not adjust the bill." 3. The hospital sent his bill to collections: "While Bhatt was trying to reach the patient advocate by phone, his bill was sent to Medicredit, a collection agency, which began sending him notices and calling him." 4. The hospital forgave the bill due to bad PR: "After KHN [Kaiser Health News] contacted SSM Health, Bhatt received a call from someone who worked on "patient financial experience" issues at the hospital. The hospital agreed to forgive the $820 facility fee." > The system worked out exactly as it should have. Could you clarify?
duped 5y ago
"No way to prevent this" Says Only Nation Where This Regularly Happens
quasarj 5y ago
tyronehed 5y ago
gedy 5y ago
I cut an m&m sized piece off the tip of my thumb with a box cutter. Went to the ER, and a nurse came out and said it wasn't too bad. Washed it in betadine and put a bandage on it and sent me home. Bill was $7000!
mathwords 5y ago
awinter-py 5y ago
Pretty sure 'surprise billing' laws that are coming down the pipe only apply to out-of-network bills, would not help cases like this. (per this https://www.cms.gov/nosurprises/Ending-Surprise-Medical-Bills https://www.cms.gov/nosurprises/Ending-Surprise-Medical-Bill...) The hospital in the article has a price transparency page here https://www.ssmhealth.com/resources/patients-visitors/pay-my-bill/price-estimate/price-transparency-disclaimer https://www.ssmhealth.com/resources/patients-visitors/pay-my... (behind multiple TOS of course). It seems to use epic / mychart. I used it to search for 'facility' and 'emergency' and got nothing. the embedded pdf bill calls this 'emergency services'. My guess is that ER facility fee isn't a 'shoppable service' under CMS definitions because it can't be scheduled in advance, but the fact that it doesn't say 'abandon $800 ye who enter here' on the front door IMO should be a crime.
- sjg007 5y ago
  In network hospitals usually can't charge a facility fee, but it will depend on your plan. Honestly, Congress needs to act on this. Most hospitals get Federal funding.
  - awinter-py 5y ago
    I'm looking at the pdf embedded in the article -- on p5 the 858.92 charge is in the 'in net medical/rx combined' section -- I assume that means it's an in-network charge? this thing https://s3.documentcloud.org/documents/21177150/january-2022-bill-of-the-month.pdf https://s3.documentcloud.org/documents/21177150/january-2022...
    - sjg007 5y ago
      Yes. They should also ask the hospital and insurer for the CPT codes billed.
theandrewbailey 5y ago
I hear these things happening all the time at hospitals. Are those urgent care places you see in mini-malls any better with respect to billing?
- gethoht 5y ago
  No, if anything they are generally worse.

56 points by grammarnazzzi 5y ago

What’s confusing is hospitals aren’t all that profitable. So where does the money go? Is it going to treat people who end up not paying? Is it going to buy expensive diagnostic equipment? Where does it go? No one seems to know.

mfer 5y ago
A lot of it goes to inefficiency. Think of it this way. If you have a factory that makes 1 thing it can optimize around that. It can become cost effective. If you have a factory that can manufacture 10 different things, it becomes less cost effective because you need to be able to switch between the different things. If a factory can produce 100 different things it's even less efficient. Hospitals deal with thousands of things. Their overhead and complexity are high. This leads to inefficiency which costs more. I've read that the math around the costs map fairly well to the cost models around factories [1]. [1] https://www.amazon.com/Innovators-Prescription-Disruptive-Solution-Health/dp/1259860868/ https://www.amazon.com/Innovators-Prescription-Disruptive-So...
seanmcdirmid 5y ago
Non profits aren’t exactly virtuous or efficient with money. In fact, there are so many players involved in operating and running a hospital who want to get paid the fact that the overall hospital itself is a non profit isn’t very meaningful.
fallingknife 5y ago
Pure inefficiency. The medical industrial complex is second only to the government in its byzantine bureaucracy. This is why we will never be rid of it. All those hundreds of billions of dollars wasted are mainly going to pay millions of middle class administrative salaries. I know 2 people whose companies would not even exist in a socialized health system. Woe to whatever politician tries to pass a bill that will put millions of middle class Americans out of work.
tyronehed 5y ago
brummm 5y ago
Also crazy large doctor salaries. The US pays way more to doctors than for example many European countries.
at_a_remove 5y ago
I have come to not view a given hospital as an entity. Rather, a hospital is a place (not just in spacetime, but in regulation, and in "the market") where numerous agents are at work in an opaque manner. Some are frantically billing anything that moves. Other agents are losing money on patients who will not or cannot pay and are looking for ways to balance those books so that they can continue to survive (consider the hospitals closing along the border as the "undocumented" end up in the ER). You have ambulance services struggling as people "cleverly" use them as taxis. Pharma slithers in and out, hoping to recoup their costs on nineteen failing drugs with wild sales of the twentieth. All of this occurs in the hospital "zone," and what patients see is a series of bills emitted, like push notifications out of an API. Making all of this predictable, transparent, and detangled is only step one. Hitting people -- actual humans -- with fraud charges is also a grand idea.
grammarnazzzi 5y ago
You can do wonders with accounting when you have control and collusion with your vertical markets.

grammarnazzzi 5y ago

> Hospital officials defend these fees as necessary to keep an emergency room open 24 hours a day as a community asset. What nonsense. This argument is effectively charging a rent without the consent or agreement of the renter (the community). If the service were reasonable, the community would agree to them. They are not, so the hostipital instead games the insurance system and preys on individuals without the resourses/ability to defend against their predation

m-p-3 5y ago
The fact that hospitals are privatized and not owned by the community is IMO the root of the problem.
- Dwolb 5y ago
  Everyone has an opinion on the root of the problem but I’d like to see an actual analysis with the costs and revenues in our medical system to better understand what’s happening. Does anyone have a good one?
  - toomuchtodo 5y ago
    https://www.harvardmagazine.com/2020/05/feature-forum-costliest-health-care https://www.harvardmagazine.com/2020/05/feature-forum-costli... https://www.kff.org/health-costs/issue-brief/americans-challenges-with-health-care-costs/ https://www.kff.org/health-costs/issue-brief/americans-chall... https://insights.som.yale.edu/insights/why-is-healthcare-so-expensive https://insights.som.yale.edu/insights/why-is-healthcare-so-...
  - coliveira 5y ago
    Most countries have already figured out that the problem is privatized medicine and created universal health care systems.
  - fallingknife 5y ago
    https://www.mckinsey.com/~/media/mckinsey/dotcom/client_service/Healthcare%20Systems%20and%20Services/Health%20International/HI08_American_health.ashx https://www.mckinsey.com/~/media/mckinsey/dotcom/client_serv...

mfer 5y ago

The financials around US hospitals are something most don't understand. I didn't for a long time. For example, many procedures at a hospital lose the hospital money. They don't cover the cost. Other things cost more and make up the difference. Another element is that most US hospitals are very inefficient in what they do. In the book The innovator's prescription you can read the technical details on how those inefficiencies happen.

duped 5y ago
Healthcare isn't supposed to make money, it's supposed to stave off death. Just like schools aren't supposed to make money, or the postal service, or the military. Framing things in the context of whether or not critical services to society make or lose money puts it in a fundamentally unfair context. I don't want hospitals to make a profit, or generate revenue. Every procedure should be losing money.
- refurb 5y ago
  How do you pay staff without revenue? Building maintenance? Garbage collection? Even communist systems had budgets and financial rules.
  - duped 5y ago
    - refurb 5y ago
      So use tax money to pay hospitals so they have revenue? That was entirely my point.
- mfer 5y ago
  Hospitals need to break even on finances. What they take in needs to cover their costs. Anything other than this needs to be subsidized by an outside organization.

dfxm12 5y ago

1. Buy expensive health insurance to cover medical bills 2. Never use it because even though you have no idea what you're going to be charged, you know it is going to be outrageous, even though you have insurance to cover medical bills What a racket...

Spivak 5y ago
The only sane play in the US is 1. Buy an inexpensive high deductible insurance plan to cover only emergency expenses. 1.1. Make sure that for your plan out-of-network expenses count toward your oopm. (1.2. Cry because your employer's health plan doesn't work for this.) 1.3. Have enough cash liquid to cover your oopm. 2. Max out your HSA contributions. 3. Pay cash for everything. Sans 1.2. this has been working reasonably well for me. You would be amazed at the discounts you get once you say you're paying cash. Medical expenses suddenly are downright reasonably priced. tl;dr Surprise! Everything is cheaper when you have money. Oh America.
- awinter-py 5y ago
  out of curiosity did you try to get your employer to cover your plan on a pretax basis? what happened?
- LinuxBender 5y ago
  You would be amazed at the discounts you get once you say you're paying cash. Anecdotally I found this to be true with prescriptions. I didn't even ask for one but as soon as I told the pharmacist I was paying cash he said, "Oh, let me apply the coupon for you." and gave me a 20% discount. It was already a cheap generic but I wasn't going to complain.
  - lazyninja987 5y ago
- toomuchtodo 5y ago
  You can short circuit this by working remotely for a US company from another country with a functioning healthcare system. If done properly (LCOL, excess income is invested), you mitigate not only healthcare system expense issues, but also can get towards a position of financial independence to mitigate the usual delays in finding your next role. For example, to have a child's broken arm evaluated and casted in a Mexico capital city is less than $100, total. Annual cost of living for a family of four is $25k-30k/US.

syki 5y ago

This what happens when a significant portion of society worships the “free market” and wants to avoid government running things. In the U.S. we have managed to fully monetize just about every aspect of life. Even something as mundane as pumping gas has been almost fully monetized by blaring ads. EDIT: I know the U.S. healthcare system isn’t a totally free market. We’ve designed a system that isn’t government run but has mandates like ERs having to see patients. Half the country labels anything that isn’t government run as free market and anything that is government run as communism. These are proxy words. If you want a healthcare system that isn’t government run but that has a semblance of “free market” in it but that also “treats” most people this is what you get. Well, it’s what our system has morphed into.

mfer 5y ago
Except, the people who have taken the time to study how the system works will tell you that's not the issue.
- jwmhjwmh 5y ago
  Other people who have also taken time to study how the system works will tell you that it is the issue.
  - refurb 5y ago
    Considering government policy in the US is a big reason for the problems, blaming capitalism is kinda funny.
    - lucian1900 5y ago
      The US government is capitalist. It primarily operates to defend the profits of large corporations. Yes, under either Democrats or Republicans, although the industries each represent only partly overlap.
      - syki 5y ago

swayvil 5y ago

maxverse 5y ago
I think this is satire?
- swayvil 5y ago
  I am 100% serious
ourmandave 5y ago
Downvoters hate sarcasm. Don't they realize you've suffered enough watching Season 8 six times?

maxverse 5y ago

NPR has a series of these "Bill of the Month"[1] articles about surprise medical billing, and I am not exaggerating when I say they are the single most depressing, scary, disheartening thing I read on the internet. The patients in these stories seem well-intentioned and well-prepared. They double check that their doctors are in-network. They triple-check what charges they should expect. But there's always a gotcha. There's always some hidden, between-the-lines reason hospitals come up with to charge you, and insurance won't cover. In one story, the surgeon invited an out-of-network surgical assistant into the surgery, without notice. In another [2], the labor and delivery department was classified as an ER, for a completely routine delivery. When these charges are dismissed, it's always because NPR reached out for comment, and the hospital backs down, presumably because of the bad PR. The unpredictably and seemingly arbitrary nature of medical charges makes me feel... queasy. And scared to seek medical help, which I know is what insurance companies want. Even with great insurance, which I'm lucky to have, it feels like there's nothing I can do to prevent medium-to-insane charges. The only way I can think of to try and combat medical billing is to retain a lawyer. [1] https://www.npr.org/series/651784144/bill-of-the-month https://www.npr.org/series/651784144/bill-of-the-month [2] https://www.npr.org/sections/health-shots/2020/07/22/891909610/knee-repairs-use-of-surgical-assistant-leads-to-a-costly-surprise-bill https://www.npr.org/sections/health-shots/2020/07/22/8919096... [3] https://www.npr.org/sections/health-shots/2021/10/27/1049138668/childbirth-how-hospitals-inflate-bills https://www.npr.org/sections/health-shots/2021/10/27/1049138...

maxverse 5y ago
Emphasizing this from the article: > Martand received almost no medical service. A nurse practitioner looked over the toddler, listened to his heart and stomach, and looked in his nose, mouth and ears, according to provider notes prepared by the hospital and shared with KHN by Bhatt. > The nurse didn't change the dressing on the wound or order any testing. > Emergency visits are usually classified for billing on a scale from 1 to 5. Level 1 is minor and routine; Level 5 requires complex care for life-threatening conditions. [...] Despite the lack of severity of Martand's wound and the absence of medical care, his visit was classified as Level 3, a moderate severity problem. > In an email, Zoller Mueller said the charges were "appropriate" based on the "acuity of condition, discharge instructions, vital sign monitoring, traumatic wound care [and] numerous assessments." > She added: "A patient does not have to receive additional treatment — procedure, labs, x-rays, etc. — to validate an ED [emergency department] level charge."

irrational 5y ago

I’ve come to the realization that I’d rather die than leave my family having to pay huge medical debt. America’s healthcare system is completely broken (and I’m saying that as a child of a doctor from whom I learned how truly messed up it is).

boring_twenties 5y ago
No one has to pay your debts if you die (other than your own estate, of course). It's important, however, that your heirs understand this and don't say or do anything that can later be construed as having accepted the debt.

ProAm 5y ago

If they think $858.00 is a high medical bill in the US they are in for a surprise.

bazzert 5y ago

Running an ER is enormously expensive, who do they expect should pay for it ?

yohannparis 5y ago
Everyone! Roads, water, sewage are enormous expensive, but nobody cringe about subsiding them with taxes.

ahelwer 5y ago

I recently read a book on the history of socialized healthcare in Canada[0], which was fascinating. I'm very passionate about the development of a comparable system down here in the US but realized I didn't know anything about how such a program was established in countries where it actually exists! All I knew about Canada's case was that a dude named Tommy Douglas was involved (years later he was voted the Greatest Canadian[1]) but it's a bit more complicated than that. I had four main takeaways from the book: 1. Social programs can start regionally. There's a refrain you hear continually that if, say, California were to institute a socialized health insurance system it would immediately collapse because all the "takers" would move there (absent border control) to drain its resources. Yet that's how socialized health insurance developed in Canada - it was driven by the province of Saskatchewan, which had hospitalization insurance a full decade before any involvement by the federal government. To say that regional social programs are doomed to fail is simply against historical fact. This is how federalism is supposed to work! Experimentation is done at smaller scale and success bubbles up. 2. Doctors are the enemy. This was surprising to me, because I'm friends with a good number of (residency) doctors and all are very passionate about health equality. Maybe their opinions will change once that private practice money starts rolling in, I don't know. But basically organized medicine has opposed socialized health programs in every country they have been tried - an interesting counterexample to the idea that labor organization will per se lead to better social outcomes. 3. Liberals won't get it done (and might make things worse). This makes sense if you view it as a negotiation: socialists need to be pushing hard for radical change in order for the final product to land somewhere in the middle. If you're talking about the need for moderation at the beginning of negotiations, you've already lost. A good litmus test to tell whether someone is serious about healthcare reform or just making impotent gestures in its direction. 4. Socialized healthcare means more than free access to care. In retrospect this one is obvious, but I somehow had missed it. Just having access to healthcare doesn't actually make you healthy. The social determinants of health are much more powerful than going to the doctor once years of poverty have already taken their toll. The scope very quickly expands and you start talking about housing access, food access, and just economic equality generally. [0] https://arpbooks.org/product/radical-medicine/ https://arpbooks.org/product/radical-medicine/ [1] https://youtu.be/g4_v2701GMg https://youtu.be/g4_v2701GMg

5y ago

jimbob45 5y ago

The ER visit ultimately cost $38.92. The system worked out exactly as it should have. I'm getting a bit tired of these anti-US healthcare posts day after day. Sure, there are some issues, but this is starting to feel like reformist propaganda. I, for one, am very happy with the current system and don't understand why anti-government activists want to hand the government the keys to run the healthcare system.

toomuchtodo 5y ago
"66.5 percent of all bankruptcies were tied to medical issues —either because of high costs for care or time out of work. An estimated 530,000 families turn to bankruptcy each year." [1] The data is very clear Americans pay the most for healthcare out of every other OECD nation and yet receive worse outcomes [2]. [1] https://ajph.aphapublications.org/doi/10.2105/AJPH.2018.304901 https://ajph.aphapublications.org/doi/10.2105/AJPH.2018.3049... [2] https://www.pgpf.org/blog/2020/07/how-does-the-us-healthcare-system-compare-to-other-countries https://www.pgpf.org/blog/2020/07/how-does-the-us-healthcare...
monkey_monkey 5y ago
> and don't understand why anti-government activists want to hand the government the keys to run the healthcare system. Because it mostly leads to more efficient healthcare systems. For example, the per-capita healthcare cost in the UK is less than half that of the US for broadly similar outcomes.
maxverse 5y ago
> The ER visit ultimately cost $38.92. The ER visit ultimately cost $38.92, after: 1. He tried to negotiate the bill: "Dhaval Bhatt made numerous attempts to get the hospital to reduce the charges. He also appealed to UnitedHealthcare to review the charges." 2. The hospital refused: "His efforts failed....the hospital would not adjust the bill." 3. The hospital sent his bill to collections: "While Bhatt was trying to reach the patient advocate by phone, his bill was sent to Medicredit, a collection agency, which began sending him notices and calling him." 4. The hospital forgave the bill due to bad PR: "After KHN [Kaiser Health News] contacted SSM Health, Bhatt received a call from someone who worked on "patient financial experience" issues at the hospital. The hospital agreed to forgive the $820 facility fee." > The system worked out exactly as it should have. Could you clarify?

duped 5y ago

"No way to prevent this" Says Only Nation Where This Regularly Happens

quasarj 5y ago

tyronehed 5y ago

gedy 5y ago

I cut an m&m sized piece off the tip of my thumb with a box cutter. Went to the ER, and a nurse came out and said it wasn't too bad. Washed it in betadine and put a bandage on it and sent me home. Bill was $7000!

mathwords 5y ago

awinter-py 5y ago

Pretty sure 'surprise billing' laws that are coming down the pipe only apply to out-of-network bills, would not help cases like this. (per this https://www.cms.gov/nosurprises/Ending-Surprise-Medical-Bills https://www.cms.gov/nosurprises/Ending-Surprise-Medical-Bill...) The hospital in the article has a price transparency page here https://www.ssmhealth.com/resources/patients-visitors/pay-my-bill/price-estimate/price-transparency-disclaimer https://www.ssmhealth.com/resources/patients-visitors/pay-my... (behind multiple TOS of course). It seems to use epic / mychart. I used it to search for 'facility' and 'emergency' and got nothing. the embedded pdf bill calls this 'emergency services'. My guess is that ER facility fee isn't a 'shoppable service' under CMS definitions because it can't be scheduled in advance, but the fact that it doesn't say 'abandon $800 ye who enter here' on the front door IMO should be a crime.

sjg007 5y ago
In network hospitals usually can't charge a facility fee, but it will depend on your plan. Honestly, Congress needs to act on this. Most hospitals get Federal funding.
- awinter-py 5y ago
  I'm looking at the pdf embedded in the article -- on p5 the 858.92 charge is in the 'in net medical/rx combined' section -- I assume that means it's an in-network charge? this thing https://s3.documentcloud.org/documents/21177150/january-2022-bill-of-the-month.pdf https://s3.documentcloud.org/documents/21177150/january-2022...
  - sjg007 5y ago
    Yes. They should also ask the hospital and insurer for the CPT codes billed.

theandrewbailey 5y ago

I hear these things happening all the time at hospitals. Are those urgent care places you see in mini-malls any better with respect to billing?

gethoht 5y ago
No, if anything they are generally worse.